Healthcare Provider Details

I. General information

NPI: 1205096088
Provider Name (Legal Business Name): FAMILY FACE 2 FACE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2008
Last Update Date: 10/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 W MARSHALL ST STE 112
RICHMOND VA
23230-4721
US

IV. Provider business mailing address

3105 W MARSHALL ST STE 205
RICHMOND VA
23230-4722
US

V. Phone/Fax

Practice location:
  • Phone: 804-833-7231
  • Fax:
Mailing address:
  • Phone: 804-303-4587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1104-05-001
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number1104
License Number StateVA

VIII. Authorized Official

Name: MS. TIFFANY LATOYA JOHNSON
Title or Position: DIRECTOR OF ADMINISTRATION
Credential:
Phone: 804-303-4587