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General NPI Number Information
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NPI Number | 1437561222
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC YOUTH COUNSELING
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Dates
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Enumeration Date | 05/28/2014
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Last Update Date | 05/28/2014
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Provider Practice Location Address
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Address Line | 128 COLTER DR
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City | RICHMOND
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State | VA
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Zip | 23223-1840
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Country | US
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Telephone | 703-209-0809
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Fax |
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Provider Business Mailing Address
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Address Line | 128 COLTER DR
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City | RICHMOND
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State | VA
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Zip | 23223-1840
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Country | US
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Telephone | 703-209-0809
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MYISHA RUSH
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Credential |
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Telephone | 703-209-0809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 2043
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License Number State | VA
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