Organization
PHOENIX LLC
Active
Organization
PHOENIX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY CALLAHAN PHD (OWNER)
(540) 685-4298
Entity
Organization
Contact information
Practice address
4919 BRAMBLETON AVE, ROANOKE, VA 24018-4149
(540) 685-4298
(540) 685-4299
Mailing address
4919 BRAMBLETON AVE, ROANOKE, VA 24018-4149
(540) 685-4298
(540) 685-4299
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1910-03-001
VA
Other
Enumeration date
05/12/2014
Last updated
01/20/2015
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