MEDICARE: T.O.D.A.Y.S. YOUTH SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	875-05	VA

General Provider Information

NPI Number	:	1467695338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T.O.D.A.Y.S. YOUTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	3122 W MARSHALL ST
Second Line	:	SUITE 216
City	:	RICHMOND
State	:	VA
Zip	:	23230-4726
Country	:	US
Telephone Number	:	804-355-5170
Fax Number	:	804-355-5172

Provider Business Practice Location Address
First Line	:	3122 W MARSHALL ST
Second Line	:	SUITE 216
City	:	RICHMOND
State	:	VA
Zip	:	23230-4726
Country	:	US
Telephone Number	:	804-355-5170
Fax Number	:	804-355-5172

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. KOBI JERON MULLINS
Credential	:	M.ED
Telephone Number	:	804-355-5170

Provider Enumeration Date	:	04/08/2009
Last Update Date	:	04/08/2009

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