Provider Demographics
NPI:1982167771
Name:PROSPECT PARK COUNSELING SERVICES
Entity Type:Organization
Organization Name:PROSPECT PARK COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAKEISHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHITFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-496-8399
Mailing Address - Street 1:974 E STUART DR STE D185
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2463
Mailing Address - Country:US
Mailing Address - Phone:804-496-8399
Mailing Address - Fax:
Practice Address - Street 1:974 E STUART DR STE D185
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2463
Practice Address - Country:US
Practice Address - Phone:804-496-8399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)