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General NPI Number Information
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NPI Number | 1437401403
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Entity Type | Organization
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Legal Business Name | EZETT YOUTH & FAMILY SERVICES
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Dates
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Enumeration Date | 10/15/2012
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Last Update Date | 10/15/2012
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Provider Practice Location Address
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Address Line | 209 ELSING GREEN WAY
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City | HIGHLAND SPRINGS
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State | VA
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Zip | 23075-2455
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Country | US
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Telephone | 804-252-9391
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 201
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City | HENRICO
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State | VA
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Zip | 23075-0201
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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 | DIRECTOR OF SERVICES
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Name | AMI WILLIAMS
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Credential |
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Telephone | 804-252-9391
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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 | 1592
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License Number State | VA
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