Provider Demographics
NPI:1801097753
Name:DOMINION SERVICES FOR ALL PEOPLE
Entity type:Organization
Organization Name:DOMINION SERVICES FOR ALL PEOPLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:LUCRETIA
Authorized Official - Last Name:GAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-766-2922
Mailing Address - Street 1:PO BOX 4179
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23439-4179
Mailing Address - Country:US
Mailing Address - Phone:757-766-2922
Mailing Address - Fax:757-766-2977
Practice Address - Street 1:9 MAUME CIR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-1716
Practice Address - Country:US
Practice Address - Phone:757-766-2922
Practice Address - Fax:757-766-2977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106176322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children