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General NPI Number Information
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NPI Number | 1326372244
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Entity Type | Organization
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Legal Business Name | STEP N UP YOUTH SERVICES, LLC
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Dates
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Enumeration Date | 09/24/2009
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Last Update Date | 09/24/2009
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Provider Practice Location Address
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Address Line | 20014 OAKLAND AVE
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-5709
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Country | US
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Telephone | 804-504-5066
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Fax | 804-504-5067
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Provider Business Mailing Address
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Address Line | 20014 OAKLAND AVE
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-5709
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Country | US
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Telephone | 804-504-5066
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Fax | 804-504-5067
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Authorized Official
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Title or Position | CAO/PD
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Name | MRS. KELLY LAWSON CAMPBELL
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Credential |
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Telephone | 804-504-5066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 1231
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License Number State | VA
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