Provider Demographics
NPI:1750059044
Name:PHASES THERAPY, INC.
Entity Type:Organization
Organization Name:PHASES THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:KAT
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVEREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:540-416-2850
Mailing Address - Street 1:3330 BOURBON ST STE 112
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-7333
Mailing Address - Country:US
Mailing Address - Phone:540-416-2850
Mailing Address - Fax:
Practice Address - Street 1:3330 BOURBON ST STE 112
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-7333
Practice Address - Country:US
Practice Address - Phone:540-416-2850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-01
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1215513353OtherNPI TYPE 1
VAVA0701010324OtherLPC