ENVISION ONE OUTPATIENT SERVICES, LLC (NPI# 1336542596) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336542596 |
| Entity Type | Organization |
| Organization Name | ENVISION ONE OUTPATIENT SERVICES, LLC |
| Practice Address |
15 Goodrich Ave Petersburg VA 23805-2119 |
| Practice Telephone | 8048628300 |
| Practice Fax Number | 8048628302 |
| Mailing Telephone | 8048628300 |
| Mailing Fax Number | 8048628302 |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2014-11-14 |
| Authorized Official Name | MRS. ANGELA JONES (PRESIDENT/CEO) |
| Authorized Official Telephone | 8048628300 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101Y00000X | Counselor | Behavioral Health & Social Service Providers | ||
| N | 101YP2500X |
Counselor Specialization: Professional |
Behavioral Health & Social Service Providers | ||
| N | 106H00000X | Marriage & Family Therapist | Behavioral Health & Social Service Providers | ||
| N | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 104100000X | Social Worker | Behavioral Health & Social Service Providers | ||
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| Street Address |
15 GOODRICH AVE |
| City | PETERSBURG |
| State | VA |
| Zip Code | 23805-2119 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861796039 | Envision One | Community/Behavioral Health | 15 Goodrich Ave, Petersburg, VA 23805-2119 | 2011-01-03 |
| 1841725926 | Envision One, LLC, Arts | Counselor | 15 Goodrich Ave, Petersburg, VA 23805-2119 | 2017-04-26 |
| 1467800599 | Xiao Hong Jin Md Pllc | Clinic/Center | 15 Goodrich Ave, Petersburg, VA 23805-2119 | 2016-05-31 |
| 1548666704 | Envision One Mental Health Skill Building, LLC | Community/Behavioral Health | 15 Goodrich Ave, Petersburg, VA 23805-2119 | 2014-11-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134690647 | Miles Viant | Occupational Therapist | 287 E Blvd, Petersburg, VA 23805 | 2018-12-10 |
| 1245756964 | Dexter Shabazz Lett | Registered Nurse | 10543 S. Crater Rd, S. Prince George, VA 23805 | 2017-08-15 |
| 1891145876 | Taylor Enhanced Living | Counselor | 105 Holly Hill Dive, Suite A, Petersburg, VA 23805 | 2016-06-21 |
| 1700255205 | Ina Thompson | Counselor | 272 Medical Park Boulevard, Petersburg, VA 23805 | 2015-09-15 |
| 1932582541 | Valeria Edda Madrid Malo Bohorquez | Internal Medicine | 50 Medical Park Blvd Ste C, Petersburg, VA 23805 | 2015-06-30 |
| 1548642788 | Justin Andrew Phillingane | Podiatrist | 3335 S Crater Rd Ste 500, Petersburg, VA 23805 | 2015-06-24 |
| 1225417082 | Paladin Dermatology LLC | Nurse Practitioner | 44 A& B Medical Park Blvd, Petersburg, VA 23805 | 2015-05-27 |
| 1245652544 | Family Services Inc. | Health Maintenance Organization | 1045 Gustavo Lane, Petersburg, VA 23805 | 2014-01-06 |
| 1619268075 | Charlene Belangia | Massage Therapist | 3323 S. Crater Rd, Suite B, Petersburg, VA 23805 | 2011-04-20 |
| 1760709638 | Caresouth Hha Holdings of Virginia, LLC | Home Health | 34 Medical Park Boulevard, Suite G-h, Petersburg, VA 23805 | 2010-04-30 |
| Find all providers in zip 23805 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801426291 | Patrice Nicole Shuford | Counselor | 1430 Farmer St, Petersburg, VA 23803-3941 | 2020-01-24 |
| 1538705025 | Tyechia Michelle Parker | Counselor | 20 W Bank St Ste 8, Petersburg, VA 23803-3279 | 2019-11-20 |
| 1710467097 | Bernetta Rodgers Quinn | Counselor | 612 S Sycamore St Ste B, Petersburg, VA 23803-5837 | 2018-08-16 |
| 1124548581 | Healthyminds, Inc. | Counselor | 1250 E Washington St, Petersburg, VA 23803-3465 | 2017-06-26 |
| 1700255205 | Ina Thompson | Counselor | 272 Medical Park Boulevard, Petersburg, VA 23805 | 2015-09-15 |
| 1679996870 | Jovat Bates | Counselor | 444 Pine Ridge Rd, Petersburg, VA 23805-1320 | 2014-01-24 |
| 1831521095 | Julie Baldock Timberlake | Counselor | 21 Walnut Blvd, Suites 1-3, Petersburg, VA 23805-2109 | 2013-07-30 |
| 1053671461 | Rizing Starz,llc | Counselor | 31c South Jefferson St, Petersburg, VA 23803-4331 | 2012-05-18 |
| 1871874867 | Jay Stanton Gregor | Counselor | 15, 12th St., Petersburg, AK 99833-2155 | 2011-09-02 |
| 1215172341 | Reginald Maurice Hill | Counselor | 20 W Bank St Ste 1, Petersburg, VA 23803-3279 | 2008-12-03 |
| Find all providers in PETERSBURG | ||||
| City | PETERSBURG |
| Zip Code | 23805 |
Please comment or provide details below to improve the information on ENVISION ONE OUTPATIENT SERVICES, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.