Provider Demographics
NPI:1477240539
Name:FAMILY TIES BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:FAMILY TIES BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-235-7866
Mailing Address - Street 1:409 LAKE HAVASU DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3976
Mailing Address - Country:US
Mailing Address - Phone:757-235-7866
Mailing Address - Fax:757-242-8046
Practice Address - Street 1:11339 WINDSOR BLVD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:VA
Practice Address - Zip Code:23487-5657
Practice Address - Country:US
Practice Address - Phone:757-242-8034
Practice Address - Fax:757-242-8046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-19
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health