Provider Demographics
NPI:1104388412
Name:REFLECTIVE OUTPATIENT THERAPY LLC
Entity Type:Organization
Organization Name:REFLECTIVE OUTPATIENT THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TYEASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS-POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:804-495-3044
Mailing Address - Street 1:3500 ROSSINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-7157
Mailing Address - Country:US
Mailing Address - Phone:804-495-3044
Mailing Address - Fax:804-495-3045
Practice Address - Street 1:3500 ROSSINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-7157
Practice Address - Country:US
Practice Address - Phone:804-495-3044
Practice Address - Fax:804-495-3045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty