Provider Demographics
NPI:1255822375
Name:A VILLAGE YOUTH & FAMILY SERVICES INC.
Entity type:Organization
Organization Name:A VILLAGE YOUTH & FAMILY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHIDHRA
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, DSW
Authorized Official - Phone:804-225-0749
Mailing Address - Street 1:2025 E MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7072
Mailing Address - Country:US
Mailing Address - Phone:042-250-7498
Mailing Address - Fax:804-225-0753
Practice Address - Street 1:625 PINEY FOREST RD STE 302D
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-2869
Practice Address - Country:US
Practice Address - Phone:434-264-7760
Practice Address - Fax:804-225-0753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1093138455Medicaid