Healthcare Provider Details

I. General information

NPI: 1104178367
Provider Name (Legal Business Name): FAMILY GUIDANCE OF VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8014 MIDLOTHIAN TURNPIKE SUITE 202
N. CHESTERFIELD VA
23235-5291
US

IV. Provider business mailing address

8014 MIDLOTHIAN TURNPIKE SUITE 202
N. CHESTERFIELD VA
23235-5291
US

V. Phone/Fax

Practice location:
  • Phone: 804-447-3403
  • Fax: 804-447-3419
Mailing address:
  • Phone: 804-447-3403
  • Fax: 804-447-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number130103001
License Number StateVA

VIII. Authorized Official

Name: MARANDA LUCIANO
Title or Position: CREDENTIALER
Credential:
Phone: 804-833-5633