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General NPI Number Information
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NPI Number | 1629946660
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Entity Type | Organization
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Legal Business Name | PHOENIX HOLISTIC HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 10/29/2025
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 3140 WALMSLEY BLVD
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City | RICHMOND
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State | VA
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Zip | 23234-2540
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Country | US
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Telephone | 804-393-4250
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Fax |
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Provider Business Mailing Address
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Address Line | 1248 CARMIA WAY # 1100
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-4750
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CARLYSSA LEBEAUF
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Credential | PMHNP-BC
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Telephone | 804-393-4250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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