=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659435220
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | T.O.D.A.Y.S. YOUTH SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3122 W MARSHALL ST STE 216
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23230-4734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-355-5170
-----------------------------------------------------
Fax | 804-355-5172
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3122 W MARSHALL ST STE 216
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23230-4734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-355-5170
-----------------------------------------------------
Fax | 804-355-5172
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. KOBI JERON MULLINS
-----------------------------------------------------
Credential | M.ED
-----------------------------------------------------
Telephone | 804-355-5170
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 875
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------