Provider Demographics
NPI:1912468190
Name:VILLAGE THERAPEUTIC MENTORING SERVICES LLC
Entity Type:Organization
Organization Name:VILLAGE THERAPEUTIC MENTORING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERODNICKER
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MBA
Authorized Official - Phone:804-519-4448
Mailing Address - Street 1:1 W CARY ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-5609
Mailing Address - Country:US
Mailing Address - Phone:804-647-0482
Mailing Address - Fax:
Practice Address - Street 1:1 W CARY ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-5609
Practice Address - Country:US
Practice Address - Phone:804-647-0482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health