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General NPI Number Information
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NPI Number | 1477916559
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Entity Type | Organization
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Legal Business Name | YOUTH TO WISDOM
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Dates
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Enumeration Date | 04/05/2016
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Last Update Date | 04/05/2016
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Provider Practice Location Address
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Address Line | 1611 WHITE CEDAR LN
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-5449
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Country | US
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Telephone | 804-690-8177
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Fax | 804-745-7183
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Provider Business Mailing Address
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Address Line | 1611 WHITE CEDAR LN
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-5449
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Country | US
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Telephone | 804-690-8177
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Fax | 804-745-7183
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Authorized Official
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Title or Position | ADMINISTRATOR /PARENTS ADVOCATE
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Name | MRS. MARY BROWN-BROOKS
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Credential |
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Telephone | 804-690-8177
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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 | 1401112429
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License Number State | VA
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