Provider Demographics
NPI:1710576343
Name:VISIONS OF HOPE PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:VISIONS OF HOPE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SELISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCP
Authorized Official - Phone:804-592-0491
Mailing Address - Street 1:555 SOUTHLAKE BLVD UNIT C2
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3060
Mailing Address - Country:US
Mailing Address - Phone:804-592-0491
Mailing Address - Fax:
Practice Address - Street 1:555 SOUTHLAKE BLVD UNIT C2
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-3060
Practice Address - Country:US
Practice Address - Phone:804-592-0491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-18
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health