Provider Demographics
NPI:1609634336
Name:PREMIER MENTAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:PREMIER MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAQIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-281-9316
Mailing Address - Street 1:478 DENBIGH BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-3900
Mailing Address - Country:US
Mailing Address - Phone:757-281-9316
Mailing Address - Fax:757-926-0641
Practice Address - Street 1:478 DENBIGH BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-3900
Practice Address - Country:US
Practice Address - Phone:757-281-9316
Practice Address - Fax:757-926-0641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health