Healthcare Provider Details

I. General information

NPI: 1659101749
Provider Name (Legal Business Name): CORE YOUTH AND FAMILY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 REUNION ST
CHESAPEAKE VA
23324-1471
US

IV. Provider business mailing address

601 REUNION ST
CHESAPEAKE VA
23324-1471
US

V. Phone/Fax

Practice location:
  • Phone: 757-582-3722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ELISHA GOODRICH
Title or Position: OWNER
Credential:
Phone: 757-582-3722