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General NPI Number Information
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NPI Number | 1013175629
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Entity Type | Organization
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Legal Business Name | FAMILY RESOLUTION SERVICES
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 05/30/2008
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Provider Practice Location Address
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Address Line | 2825 S CRATER RD #4
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City | PETERSBURG
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State | VA
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Zip | 23805-2473
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Country | US
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Telephone | 804-861-3540
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Fax | 804-861-3541
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Provider Business Mailing Address
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Address Line | 2825 S CRATER RD #4
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City | PETERSBURG
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State | VA
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Zip | 23805-2473
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Country | US
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Telephone | 804-861-3540
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Fax | 804-861-3541
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Authorized Official
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Title or Position | CO-EXECUTIVE DIRECTOR
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Name | BEATRICE INEZ JOHNSON
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Credential |
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Telephone | 804-304-5134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 32205001
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License Number State | VA
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