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General NPI Number Information
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NPI Number | 1821407446
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Entity Type | Organization
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Legal Business Name | ADY THERAPY SERVICES
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 08/07/2014
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Provider Practice Location Address
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Address Line | 4532 NORMAN RD
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City | PORTSMOUTH
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State | VA
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Zip | 23703-4925
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Country | US
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Telephone | 757-651-2655
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Fax | 757-606-3131
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Provider Business Mailing Address
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Address Line | 4532 NORMAN RD
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City | PORTSMOUTH
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State | VA
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Zip | 23703-4925
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Country | US
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Telephone | 757-651-2655
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Fax | 757-606-3131
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Authorized Official
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Title or Position | OWNER
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Name | ANDREA DAWN YOUNKINS
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Credential | BCBA, LBA, M.S. ED
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Telephone | 757-651-2655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0133000296
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License Number State | VA
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