Organization
PHOENIX MENTAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD M MASON JR. PHD, LPC, ACS (LPC)
(757) 453-4017
Entity
Organization
Contact information
Practice address
100 S BOGGS AVE, VIRGINIA BEACH, VA 23452-1705
(757) 453-4017
Mailing address
810 KEMPSVILLE RD STE 6, VIRGINIA BEACH, VA 23464-2723
(757) 453-4017
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
0701003229
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1891042438
NPI
VA
Enumeration date
07/16/2013
Last updated
07/22/2013
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