Healthcare Provider Details

I. General information

NPI: 1861724825
Provider Name (Legal Business Name): YOUTH DEVELOPMENT COUNSELING AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 N 30TH ST
RICHMOND VA
23223-5344
US

IV. Provider business mailing address

1516 N 30TH ST
RICHMOND VA
23223-5344
US

V. Phone/Fax

Practice location:
  • Phone: 804-252-4118
  • Fax:
Mailing address:
  • Phone: 804-252-4118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number149205001
License Number StateVA

VIII. Authorized Official

Name: RAYMOND LAMONT CHERRY
Title or Position: CHAIRMAN
Credential:
Phone: 804-350-7070