Provider Demographics
NPI:1114648045
Name:FIRST ACCESS SUPPORT SERVICES
Entity Type:Organization
Organization Name:FIRST ACCESS SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL CONSULTANT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEMBERLY
Authorized Official - Middle Name:LILES
Authorized Official - Last Name:RAINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, LSATP
Authorized Official - Phone:804-248-6964
Mailing Address - Street 1:6013 MANOR HOUSE TRL
Mailing Address - Street 2:
Mailing Address - City:MOSELEY
Mailing Address - State:VA
Mailing Address - Zip Code:23120-2248
Mailing Address - Country:US
Mailing Address - Phone:804-248-6964
Mailing Address - Fax:
Practice Address - Street 1:5262 CHAMBERLAYNE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-2950
Practice Address - Country:US
Practice Address - Phone:804-503-8940
Practice Address - Fax:888-743-3475
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST ACCESS SUPPORT SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health