Provider Demographics
NPI:1114439221
Name:POSITIVE DEVELOPMENT GROUP
Entity Type:Organization
Organization Name:POSITIVE DEVELOPMENT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAREETA
Authorized Official - Middle Name:TANELL
Authorized Official - Last Name:GLASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-918-5715
Mailing Address - Street 1:PO BOX 13701
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-8701
Mailing Address - Country:US
Mailing Address - Phone:804-918-5715
Mailing Address - Fax:800-729-0160
Practice Address - Street 1:6972 FOREST HILL AVE FL 2
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-1654
Practice Address - Country:US
Practice Address - Phone:804-918-5715
Practice Address - Fax:800-729-0160
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POSITIVE DEVELOPMENT GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA249805001101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty