Provider Demographics
NPI:1104178367
Name:FAMILY GUIDANCE OF VIRGINIA
Entity Type:Organization
Organization Name:FAMILY GUIDANCE OF VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALER
Authorized Official - Prefix:
Authorized Official - First Name:MARANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-833-5633
Mailing Address - Street 1:8014 MIDLOTHIAN TURNPIKE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:N. CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5291
Mailing Address - Country:US
Mailing Address - Phone:804-447-3403
Mailing Address - Fax:804-447-3419
Practice Address - Street 1:8014 MIDLOTHIAN TURNPIKE
Practice Address - Street 2:SUITE 202
Practice Address - City:N. CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5291
Practice Address - Country:US
Practice Address - Phone:804-447-3403
Practice Address - Fax:804-447-3419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA130103001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health