Provider Demographics
NPI:1174705248
Name:FORENSIC AND MENTAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:FORENSIC AND MENTAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:BETHANY
Authorized Official - Last Name:MAGAZINE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:804-722-0620
Mailing Address - Street 1:6610 COMMONS DR
Mailing Address - Street 2:STE 103
Mailing Address - City:PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23875-2528
Mailing Address - Country:US
Mailing Address - Phone:804-722-0620
Mailing Address - Fax:804-722-0621
Practice Address - Street 1:6610 COMMONS DR
Practice Address - Street 2:STE 103
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-2528
Practice Address - Country:US
Practice Address - Phone:804-722-0620
Practice Address - Fax:804-722-0621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health