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General NPI Number Information
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NPI Number | 1184555682
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Entity Type | Organization
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Legal Business Name | JOURNEY TO PROSPERITY MENTAL HEALTH
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Dates
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Enumeration Date | 05/26/2026
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Last Update Date | 05/26/2026
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Provider Practice Location Address
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Address Line | 30 FRANKLIN ST STE AND208
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City | PETERSBURG
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State | VA
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Zip | 23803-4504
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Country | US
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Telephone | 804-946-5764
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Fax | 757-720-3584
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Provider Business Mailing Address
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Address Line | 30 FRANKLIN ST STE AND208
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City | PETERSBURG
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State | VA
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Zip | 23803-4504
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Country | US
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Telephone | 804-946-5764
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Fax | 757-720-3584
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Authorized Official
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Title or Position | COOWNER
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Name | SHANTA DENARD CLAY
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Credential | LCSW
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Telephone | 224-425-9388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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