Provider Demographics
NPI:1841449089
Name:CORNERSTONE YOUTH SERVICES, LLC
Entity type:Organization
Organization Name:CORNERSTONE YOUTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:YOUNG
Authorized Official - Last Name:MCCLENDON
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MED
Authorized Official - Phone:804-683-8926
Mailing Address - Street 1:3117 W CLAY ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-4731
Mailing Address - Country:US
Mailing Address - Phone:804-683-8926
Mailing Address - Fax:804-864-9439
Practice Address - Street 1:3117 W CLAY ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-4731
Practice Address - Country:US
Practice Address - Phone:804-683-8926
Practice Address - Fax:804-864-9439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA133659252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency