Provider Demographics
NPI:1477893428
Name:INTERNALIZE MENTAL HEALTH PERSPECTIVE SERVICES , LLC
Entity Type:Organization
Organization Name:INTERNALIZE MENTAL HEALTH PERSPECTIVE SERVICES , LLC
Other - Org Name:IMHPS,LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACALYN
Authorized Official - Middle Name:DENICE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-723-4766
Mailing Address - Street 1:1733 FIRST COLONIAL CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-6892
Mailing Address - Country:US
Mailing Address - Phone:804-723-4766
Mailing Address - Fax:804-222-8122
Practice Address - Street 1:7277 HANOVER GREEN DR STE A1
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-1764
Practice Address - Country:US
Practice Address - Phone:804-723-4766
Practice Address - Fax:804-222-8122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1842251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health