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General NPI Number Information
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NPI Number | 1235465550
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Entity Type | Organization
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Legal Business Name | YOUTH SERVICES OF VIRGINIA
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Dates
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Enumeration Date | 10/21/2009
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Last Update Date | 10/21/2009
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Provider Practice Location Address
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Address Line | 6802 PARAGON PL STE 210
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City | RICHMOND
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State | VA
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Zip | 23230-1655
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Country | US
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Telephone | 610-742-1679
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Fax |
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Provider Business Mailing Address
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Address Line | 6802 PARAGON PL STE 210
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City | RICHMOND
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State | VA
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Zip | 23230-1655
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JASON RYAN CANNON
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Credential |
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Telephone | 610-742-1679
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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 | 1417-05-001
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License Number State | VA
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