Provider Demographics
NPI:1699326710
Name:PHOENIX FAMILY SERVICES, LLC
Entity type:Organization
Organization Name:PHOENIX FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNTH
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:PRYOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP
Authorized Official - Phone:804-986-1121
Mailing Address - Street 1:5206 MARKEL RD STE 301
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3044
Mailing Address - Country:US
Mailing Address - Phone:180-450-5473
Mailing Address - Fax:804-505-4737
Practice Address - Street 1:5206 MARKEL RD STE 301
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3044
Practice Address - Country:US
Practice Address - Phone:804-505-4737
Practice Address - Fax:804-505-5179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1699326710Medicaid
VA1407329857Medicaid