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General NPI Number Information
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NPI Number | 1831855220
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Entity Type | Organization
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Legal Business Name | PHOENIX CONSULTING & BEHAVIOR THERAPY, LLC
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Dates
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Enumeration Date | 11/10/2021
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 919 E MAIN ST STE 1000
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City | RICHMOND
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State | VA
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Zip | 23219-4623
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Country | US
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Telephone | 703-935-6670
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Fax |
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Provider Business Mailing Address
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Address Line | 11507 WILDERNESS PARK DR
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City | SPOTSYLVANIA
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State | VA
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Zip | 22551-8336
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Country | US
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Telephone | 703-935-6670
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | ALEXXANDRA M KERSSE
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Credential |
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Telephone | 703-935-6670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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