Healthcare Provider Details

I. General information

NPI: 1174453872
Provider Name (Legal Business Name): FAMILY TIES YOUTH EMPOWERMENT HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 LAKE HAVASU DR
VIRGINIA BEACH VA
23454-3976
US

IV. Provider business mailing address

409 LAKE HAVASU DR
VIRGINIA BEACH VA
23454-3976
US

V. Phone/Fax

Practice location:
  • Phone: 757-235-7866
  • Fax:
Mailing address:
  • Phone: 757-235-7866
  • Fax: 757-242-8046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SHAMEKA VALANDA WOODLEY
Title or Position: OWNER / MEMBER / CEO / ADMIN.
Credential: QMHP
Phone: 757-235-7866