=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437480688
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABRAHAM YOUTH & FAMILY SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2010
-----------------------------------------------------
Last Update Date | 01/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1510 WILLOW LAWN DR
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23230-3429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-675-9204
-----------------------------------------------------
Fax | 804-320-0770
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 35099
-----------------------------------------------------
City | NORTH CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23235-0099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-675-9204
-----------------------------------------------------
Fax | 804-320-0770
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. TONIA DANIELLE HAMLIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-675-9204
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------