Provider Demographics
NPI:1104371350
Name:YOUTH DEVELOPMENT COUNSELING AGENCY, INC.
Entity Type:Organization
Organization Name:YOUTH DEVELOPMENT COUNSELING AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELMAGID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-252-4118
Mailing Address - Street 1:5731 S LABURNUM AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-4431
Mailing Address - Country:US
Mailing Address - Phone:804-328-0200
Mailing Address - Fax:
Practice Address - Street 1:5731 S LABURNUM AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-4431
Practice Address - Country:US
Practice Address - Phone:804-328-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1492-03-001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health