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General NPI Number Information
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NPI Number | 1609418821
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Entity Type | Organization
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Legal Business Name | SOLID ROCK FAMILY LIFE CENTER, LLC
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Dates
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Enumeration Date | 10/09/2019
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 140 W WASHINGTON ST STE 108
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City | SUFFOLK
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State | VA
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Zip | 23434-5254
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Country | US
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Telephone | 757-539-0315
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Fax | 757-539-0317
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Provider Business Mailing Address
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Address Line | 123 E TELLIE LAWRENCE RD
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City | MURFREESBORO
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State | NC
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Zip | 27855-9720
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Country | US
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Telephone | 252-287-8713
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. PHYLLISTINE SIMMONS
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Credential |
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Telephone | 252-287-3562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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