Provider Demographics
NPI:1326372244
Name:STEP N UP YOUTH SERVICES, LLC
Entity Type:Organization
Organization Name:STEP N UP YOUTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO/PD
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:LAWSON
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-504-5066
Mailing Address - Street 1:20014 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-5709
Mailing Address - Country:US
Mailing Address - Phone:804-504-5066
Mailing Address - Fax:804-504-5067
Practice Address - Street 1:20014 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-5709
Practice Address - Country:US
Practice Address - Phone:804-504-5066
Practice Address - Fax:804-504-5067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1231322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children