Provider Demographics
NPI:1124197991
Name:YOUTH INTERVENTION SERVICES, LLC
Entity Type:Organization
Organization Name:YOUTH INTERVENTION SERVICES, LLC
Other - Org Name:CHANGE NAME: YOUTH A FAMILY COUNSELING SERVICES, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:757-499-4320
Mailing Address - Street 1:1518 WILLOW LAWN DRIVE
Mailing Address - Street 2:#201
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230
Mailing Address - Country:US
Mailing Address - Phone:804-266-9474
Mailing Address - Fax:804-266-9476
Practice Address - Street 1:1518 WILLOW LAWN DRIVE
Practice Address - Street 2:#201
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230
Practice Address - Country:US
Practice Address - Phone:804-266-9476
Practice Address - Fax:804-266-9476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA843322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children