MEDICARE: ASSOCIATED FAMILY AND GROUP

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	1041C0700X	Clinical Social Worker	0904006248	VA

General Provider Information

NPI Number	:	1881880367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATED FAMILY AND GROUP

Provider Business Mailing Address
First Line	:	3212 SKIPWITH RD
Second Line	:	SUITE 104
City	:	RICHMOND
State	:	VA
Zip	:	23294-4413
Country	:	US
Telephone Number	:	804-270-4068
Fax Number	:	804-273-0851

Provider Business Practice Location Address
First Line	:	3212 SKIPWITH RD
Second Line	:	SUITE 104
City	:	RICHMOND
State	:	VA
Zip	:	23294-4413
Country	:	US
Telephone Number	:	804-270-4068
Fax Number	:	804-273-0851

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JEFFREY T LLOYD
Credential	:	LCSW
Telephone Number	:	804-270-4068

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	09/19/2007

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