Organization
PERSPECTIVE HEALTH SERVICES GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER MANGUM (CHIEF EXECUTIVE OFFICER)
(919) 641-5938
Entity
Organization
Contact information
Practice address
3152 HALIFAX RD, E, SOUTH BOSTON, VA 24592-4906
(919) 641-5938
Mailing address
3152 HALIFAX RD, E, SOUTH BOSTON, VA 24592-4906
(919) 641-5938
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TP0016X
Prescribing (Medical) Psychologist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275833774
—
VA
Enumeration date
01/23/2015
Last updated
01/23/2015
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