Organization
PHASES FAMILY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ETHEL WILLIAMSON RIDDICK-MAYO QMHP (OWNER)
(757) 376-0149
Entity
Organization
Contact information
Practice address
27037 FLAGGY RUN RD, COURTLAND, VA 23837-2518
(757) 376-0149
Mailing address
27037 FLAGGY RUN RD, COURTLAND, VA 23837-2518
(757) 376-0149
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
07/06/2023
Last updated
07/06/2023
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