Healthcare Provider Details

I. General information

NPI: 1538080270
Provider Name (Legal Business Name): J R ADULT AND YOUTH MENTORING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 HELENA LN
SHIPMAN VA
22971-2358
US

IV. Provider business mailing address

60 HELENA LN
SHIPMAN VA
22971-2358
US

V. Phone/Fax

Practice location:
  • Phone: 434-806-9836
  • Fax:
Mailing address:
  • Phone: 434-806-9836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. LLOYD LEWIS GRAY JR.
Title or Position: CEO
Credential:
Phone: 434-806-9836