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General NPI Number Information
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NPI Number | 1699326710
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Entity Type | Organization
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Legal Business Name | PHOENIX FAMILY SERVICES, LLC
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Dates
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Enumeration Date | 09/20/2019
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 5206 MARKEL RD STE 301
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City | RICHMOND
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State | VA
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Zip | 23230-3044
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Country | US
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Telephone | 804-505-4737
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Fax | 804-505-5179
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Provider Business Mailing Address
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Address Line | 5206 MARKEL RD STE 301
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City | RICHMOND
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State | VA
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Zip | 23230-3044
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Country | US
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Telephone | 180-450-5473
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Fax | 804-505-4737
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KENNTH JASON PRYOR
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Credential | LMHP
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Telephone | 804-986-1121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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