Healthcare Provider Details

I. General information

NPI: 1730608217
Provider Name (Legal Business Name): INTERCEPT YOUTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 11/09/2025
Certification Date: 11/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5673 AIRPORT RD
ROANOKE VA
24012-1119
US

IV. Provider business mailing address

5511 STAPLES MILL RD STE 102
HENRICO VA
23228-5445
US

V. Phone/Fax

Practice location:
  • Phone: 540-523-8080
  • Fax: 540-512-9775
Mailing address:
  • Phone: 804-864-1320
  • Fax: 804-422-0840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number100032497
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: YOLANDA WINFIELD
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 804-807-1201