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General NPI Number Information
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NPI Number | 1508199241
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Entity Type | Organization
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Legal Business Name | FAMILY AND ADOLESCENT SERVICES
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Dates
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Enumeration Date | 09/14/2009
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Last Update Date | 09/14/2009
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Provider Practice Location Address
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Address Line | 501 E FRANKLIN ST SUITE 414
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City | RICHMOND
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State | VA
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Zip | 23219-2322
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Country | US
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Telephone | 804-521-4450
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Fax | 804-521-4071
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Provider Business Mailing Address
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Address Line | 501 E FRANKLIN ST SUITE 414
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City | RICHMOND
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State | VA
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Zip | 23219-2322
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Country | US
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Telephone | 804-521-4450
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Fax | 804-521-4071
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | LAWRENCE EUGENE WOODSON
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Credential | ED,D,
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Telephone | 804-387-0593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 942
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License Number State | VA
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