Provider Demographics
NPI:1326804493
Name:PRECIOUS MOMENTS MENTAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:PRECIOUS MOMENTS MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-717-8984
Mailing Address - Street 1:124 HIGHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-9270
Mailing Address - Country:US
Mailing Address - Phone:757-717-8984
Mailing Address - Fax:
Practice Address - Street 1:124 HIGHFIELD RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-9270
Practice Address - Country:US
Practice Address - Phone:757-717-8984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health