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General NPI Number Information
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NPI Number | 1205096088
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Entity Type | Organization
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Legal Business Name | FAMILY FACE 2 FACE SERVICES, LLC
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Dates
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Enumeration Date | 06/14/2008
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Last Update Date | 10/19/2009
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Provider Practice Location Address
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Address Line | 3105 W MARSHALL ST STE 112
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City | RICHMOND
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State | VA
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Zip | 23230-4721
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Country | US
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Telephone | 804-833-7231
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Fax |
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Provider Business Mailing Address
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Address Line | 3105 W MARSHALL ST STE 205
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City | RICHMOND
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State | VA
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Zip | 23230-4722
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Country | US
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Telephone | 804-303-4587
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF ADMINISTRATION
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Name | MS. TIFFANY LATOYA JOHNSON
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Credential |
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Telephone | 804-303-4587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 1104
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1104-05-001
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License Number State | VA
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