Healthcare Provider Details

I. General information

NPI: 1174112692
Provider Name (Legal Business Name): ABRAHAM YOUTH & FAMILY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 WILLOW LAWN DR STE 100
RICHMOND VA
23230-3429
US

IV. Provider business mailing address

PO BOX 35099
NORTH CHESTERFIELD VA
23235-0099
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-9204
  • Fax: 804-282-0040
Mailing address:
  • Phone: 804-399-0569
  • Fax: 804-282-0040

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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. TONIA HAMLIN
Title or Position: CEO/OWNER
Credential:
Phone: 804-675-9204