Provider Demographics
NPI:1619298130
Name:NDUTIME YOUTH & FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:NDUTIME YOUTH & FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TESHANA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-303-8393
Mailing Address - Street 1:518 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-1236
Mailing Address - Country:US
Mailing Address - Phone:434-336-1350
Mailing Address - Fax:434-336-1353
Practice Address - Street 1:518 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-1236
Practice Address - Country:US
Practice Address - Phone:434-336-1350
Practice Address - Fax:434-336-1353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA758251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health