Provider Demographics
NPI:1851030274
Name:FREDERICKSBURG AREA HEALTH AND SUPPORT SERVICES
Entity Type:Organization
Organization Name:FREDERICKSBURG AREA HEALTH AND SUPPORT SERVICES
Other - Org Name:FREDERICKSBURG AREA HIV/AIDS SUPPORT SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LYTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-907-4555
Mailing Address - Street 1:4343 PLANK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-4807
Mailing Address - Country:US
Mailing Address - Phone:540-993-4473
Mailing Address - Fax:
Practice Address - Street 1:10514 WAKEMAN DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-8040
Practice Address - Country:US
Practice Address - Phone:540-993-4473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREDERICKSBURG AREA HEALTH AND SUPPORT SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-02
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty