Healthcare Provider Details

I. General information

NPI: 1235298621
Provider Name (Legal Business Name): FAMILY IMPACT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 B TURNER RD SUITE B
RICHMOND VA
23225
US

IV. Provider business mailing address

300 A TURNER ROAD SUITE A
RICHMOND VA
23225
US

V. Phone/Fax

Practice location:
  • Phone: 804-276-1777
  • Fax: 804-276-1877
Mailing address:
  • Phone: 804-276-1777
  • Fax: 804-276-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number784
License Number StateVA

VIII. Authorized Official

Name: RUTH FELICIA MATTOCKS
Title or Position: PRESIDENT
Credential:
Phone: 804-276-1777