Provider Demographics
NPI:1598917171
Name:FAMILY & YOUTH FOUNDATIONS COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:FAMILY & YOUTH FOUNDATIONS COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:SANKOFA
Authorized Official - Suffix:SR
Authorized Official - Credentials:MSW
Authorized Official - Phone:757-771-0633
Mailing Address - Street 1:12388 WARWICK BLVD
Mailing Address - Street 2:SUITE 210-C
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3850
Mailing Address - Country:US
Mailing Address - Phone:757-771-0633
Mailing Address - Fax:757-337-2919
Practice Address - Street 1:12388 WARWICK BLVD
Practice Address - Street 2:SUITE 210-C
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3850
Practice Address - Country:US
Practice Address - Phone:757-771-0633
Practice Address - Fax:757-337-2919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health