Provider Demographics
NPI:1982043170
Name:PHEONIX MENTAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:PHEONIX MENTAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD,LPC
Authorized Official - Phone:757-619-2984
Mailing Address - Street 1:810 KEMPSVILLE RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-2723
Mailing Address - Country:US
Mailing Address - Phone:757-619-2984
Mailing Address - Fax:
Practice Address - Street 1:810 KEMPSVILLE RD
Practice Address - Street 2:SUITE 6
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-2723
Practice Address - Country:US
Practice Address - Phone:757-619-2984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001079101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty