MEDICARE: REACHING ADULTS AND YOUTH FAMILY SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1679064570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REACHING ADULTS AND YOUTH FAMILY SERVICES LLC

Provider Business Mailing Address
First Line	:	1403 GREENVILLE AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-6912
Country	:	US
Telephone Number	:	804-308-3948
Fax Number	:

Provider Business Practice Location Address
First Line	:	1403 GREENVILLE AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-6912
Country	:	US
Telephone Number	:	804-308-3948
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RAYMOND EDWARD LONEY
Credential	:	QMHP
Telephone Number	:	804-308-3948

Provider Enumeration Date	:	05/25/2018
Last Update Date	:	05/25/2018

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