Provider Demographics
NPI:1073766515
Name:INNOVATIVE FAMILY CONSULTANTS, INC.
Entity Type:Organization
Organization Name:INNOVATIVE FAMILY CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP
Authorized Official - Phone:434-426-1311
Mailing Address - Street 1:21731 TIMBERLAKE RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-7400
Mailing Address - Country:US
Mailing Address - Phone:434-455-5033
Mailing Address - Fax:434-455-5034
Practice Address - Street 1:21731 TIMBERLAKE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-7400
Practice Address - Country:US
Practice Address - Phone:434-455-5033
Practice Address - Fax:434-455-5034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA102705001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health