Provider Demographics
NPI:1164517157
Name:YOUTH EXPERIENCING SUCCESS, INC.
Entity Type:Organization
Organization Name:YOUTH EXPERIENCING SUCCESS, INC.
Other - Org Name:TRADING AS T/A DOT'S PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:VERONICA HICKS
Authorized Official - Middle Name:L
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:804-329-5200
Mailing Address - Street 1:2804 2ND AVENUE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-3909
Mailing Address - Country:US
Mailing Address - Phone:804-329-5200
Mailing Address - Fax:
Practice Address - Street 1:2804 2ND AVENUE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-3909
Practice Address - Country:US
Practice Address - Phone:804-329-5200
Practice Address - Fax:804-329-5202
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUTH EXPERIENCING SUCCESS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-04
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VASS-04-07320800000X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children