Provider Demographics
NPI:1699227561
Name:HEALING STRIDES OF VA
Entity Type:Organization
Organization Name:HEALING STRIDES OF VA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-334-5825
Mailing Address - Street 1:PO BOX 455
Mailing Address - Street 2:672 NAFF RD.,
Mailing Address - City:BOONES MILL
Mailing Address - State:VA
Mailing Address - Zip Code:24065-0455
Mailing Address - Country:US
Mailing Address - Phone:540-334-5825
Mailing Address - Fax:540-334-2941
Practice Address - Street 1:672 NAFF RD
Practice Address - Street 2:
Practice Address - City:BOONES MILL
Practice Address - State:VA
Practice Address - Zip Code:24065-1992
Practice Address - Country:US
Practice Address - Phone:540-334-5825
Practice Address - Fax:540-334-2941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904008347251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health