Provider Demographics
NPI:1942989264
Name:JOURNEY PSYCHOTHERAPY, LLC.
Entity Type:Organization
Organization Name:JOURNEY PSYCHOTHERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLASIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:757-977-1500
Mailing Address - Street 1:1530 BREEZEPORT WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3753
Mailing Address - Country:US
Mailing Address - Phone:757-977-1500
Mailing Address - Fax:
Practice Address - Street 1:235 FALLAWATER WAY
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-9263
Practice Address - Country:US
Practice Address - Phone:757-319-6067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty