Healthcare Provider Details

I. General information

NPI: 1841449089
Provider Name (Legal Business Name): CORNERSTONE YOUTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3117 W CLAY ST
RICHMOND VA
23230-4731
US

IV. Provider business mailing address

3117 W CLAY ST
RICHMOND VA
23230-4731
US

V. Phone/Fax

Practice location:
  • Phone: 804-683-8926
  • Fax: 804-864-9439
Mailing address:
  • Phone: 804-683-8926
  • Fax: 804-864-9439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number133659
License Number StateVA

VIII. Authorized Official

Name: MRS. SHARON YOUNG MCCLENDON
Title or Position: DIRECTOR
Credential: B.S., M.ED.
Phone: 804-683-8926