=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265704407
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY AND ADOLESCENT SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2012
-----------------------------------------------------
Last Update Date | 02/03/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 E FRANKLIN ST STE 414
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23219-2330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-521-4450
-----------------------------------------------------
Fax | 804-521-4071
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 E FRANKLIN ST STE 414
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23219-2330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-521-4450
-----------------------------------------------------
Fax | 804-521-4071
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | DR. LAWRENCE EUGENE WOODSON
-----------------------------------------------------
Credential | ED. D.
-----------------------------------------------------
Telephone | 804-521-4450
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 942
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------