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General NPI Number Information
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NPI Number | 1982043170
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Entity Type | Organization
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Legal Business Name | PHEONIX MENTAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 06/20/2013
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Last Update Date | 06/20/2013
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Provider Practice Location Address
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Address Line | 810 KEMPSVILLE RD SUITE 6
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-2723
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Country | US
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Telephone | 757-619-2984
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Fax |
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Provider Business Mailing Address
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Address Line | 810 KEMPSVILLE RD SUITE 6
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-2723
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Country | US
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Telephone | 757-619-2984
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. ROSEMARY A THOMPSON
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Credential | ED.D.,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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0701001079
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License Number State | VA
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