Provider Demographics
NPI:1720392319
Name:FAMILY AND ADOLESCENT SERVICES, LLC
Entity Type:Organization
Organization Name:FAMILY AND ADOLESCENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOODSON
Authorized Official - Suffix:
Authorized Official - Credentials:ED D
Authorized Official - Phone:804-521-4050
Mailing Address - Street 1:501 E FRANKLIN ST
Mailing Address - Street 2:SUITE 414
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-2322
Mailing Address - Country:US
Mailing Address - Phone:804-521-4450
Mailing Address - Fax:804-521-4071
Practice Address - Street 1:501 E FRANKLIN ST
Practice Address - Street 2:SUITE 414
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-2322
Practice Address - Country:US
Practice Address - Phone:804-521-4450
Practice Address - Fax:804-521-4071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-06
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA942101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1508199241Medicaid
VA1124225933Medicaid