Provider Demographics
NPI:1760663306
Name:MMJ FAMILY SERVICES
Entity Type:Organization
Organization Name:MMJ FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAWANNA
Authorized Official - Middle Name:CHENA
Authorized Official - Last Name:MITCHELL-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CSOTP
Authorized Official - Phone:804-745-1250
Mailing Address - Street 1:PO BOX 2080
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-9110
Mailing Address - Country:US
Mailing Address - Phone:804-745-1250
Mailing Address - Fax:804-745-1172
Practice Address - Street 1:7435 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-6411
Practice Address - Country:US
Practice Address - Phone:804-745-1250
Practice Address - Fax:804-745-1172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization