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General NPI Number Information
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NPI Number | 1477893428
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Entity Type | Organization
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Legal Business Name | INTERNALIZE MENTAL HEALTH PERSPECTIVE SERVICES , LLC
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Dates
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Enumeration Date | 02/27/2013
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Last Update Date | 09/20/2016
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Provider Practice Location Address
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Address Line | 7277 HANOVER GREEN DR STE A1
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City | MECHANICSVILLE
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State | VA
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Zip | 23111-1764
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Country | US
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Telephone | 804-723-4766
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Fax | 804-222-8122
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Provider Business Mailing Address
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Address Line | 1733 FIRST COLONIAL CT
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City | RICHMOND
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State | VA
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Zip | 23231-6892
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Country | US
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Telephone | 804-723-4766
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Fax | 804-222-8122
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. JACALYN DENICE JACKSON
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Credential |
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Telephone | 804-723-4766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1842
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License Number State | VA
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