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General NPI Number Information
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NPI Number | 1710429972
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Entity Type | Organization
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Legal Business Name | PHOENIX MENTAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 11/04/2016
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Last Update Date | 11/04/2016
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Provider Practice Location Address
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Address Line | 1117 HORN POINT RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-4142
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Country | US
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Telephone | 757-619-2984
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Fax | 757-721-6115
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Provider Business Mailing Address
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Address Line | 1117 HORN POINT RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-4142
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Country | US
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Telephone | 757-619-2984
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Fax | 757-721-6115
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROSEMARY A THOMPSON
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Credential | LPC
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Telephone | 757-619-2984
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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 | 701001079
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License Number State | VA
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