Healthcare Provider Details

I. General information

NPI: 1902724420
Provider Name (Legal Business Name): FLUVANNA YOUTH MENTORING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 OAK GROVE RD
PALMYRA VA
22963-2534
US

IV. Provider business mailing address

34 OAK GROVE RD
PALMYRA VA
22963-2534
US

V. Phone/Fax

Practice location:
  • Phone: 434-995-9339
  • Fax:
Mailing address:
  • Phone: 434-995-9339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: AARON WOOD
Title or Position: OWNER
Credential: MSHS, QMHP
Phone: 434-995-9339