Provider Demographics
NPI:1164844635
Name:VILLAGE YOUTH AND FAMILY SERVICES
Entity Type:Organization
Organization Name:VILLAGE YOUTH AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ CLINICIAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KHIDHRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-551-7363
Mailing Address - Street 1:564 SIENA LANE
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059
Mailing Address - Country:US
Mailing Address - Phone:804-551-7363
Mailing Address - Fax:
Practice Address - Street 1:564 SIENA LN
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-1115
Practice Address - Country:US
Practice Address - Phone:804-551-7363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health