Provider Demographics
NPI:1215211982
Name:STRATEGIC YOUTH SERVICES, LLC
Entity Type:Organization
Organization Name:STRATEGIC YOUTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-901-7823
Mailing Address - Street 1:6767 FOREST HILL AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-1856
Mailing Address - Country:US
Mailing Address - Phone:804-901-7823
Mailing Address - Fax:
Practice Address - Street 1:6767 FOREST HILL AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-1856
Practice Address - Country:US
Practice Address - Phone:804-901-7823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1640251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health