Provider Demographics
NPI:1952073355
Name:FIRST HEART RESIDENTIAL SERVICES, LLC
Entity Type:Organization
Organization Name:FIRST HEART RESIDENTIAL SERVICES, LLC
Other - Org Name:TRINITY COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:757-524-0461
Mailing Address - Street 1:1245G CEDAR RD # 223
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-7103
Mailing Address - Country:US
Mailing Address - Phone:757-524-0461
Mailing Address - Fax:757-800-8336
Practice Address - Street 1:525 DOROTHY CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323
Practice Address - Country:US
Practice Address - Phone:757-524-0461
Practice Address - Fax:757-800-8336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-04
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA601019218Medicaid