MEDICARE: NDUTIME YOUTH & FAMILY SERVICES, INC.

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	251S00000X	Community/Behavioral Health Agency	758	VA

General Provider Information

NPI Number	:	1689995607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NDUTIME YOUTH & FAMILY SERVICES, INC.

Provider Business Mailing Address
First Line	:	6015 STAPLES MILL RD
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23228-4923
Country	:	US
Telephone Number	:	804-303-8393
Fax Number	:	804-303-8398

Provider Business Practice Location Address
First Line	:	6015 STAPLES MILL RD
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23228-4923
Country	:	US
Telephone Number	:	804-303-8393
Fax Number	:	804-303-8398

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	MRS. TESHANA DENISE HENDERSON
Credential	:	LCSW
Telephone Number	:	804-303-8393

Provider Enumeration Date	:	06/14/2010
Last Update Date	:	06/14/2010

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