| Changing Faces Youth Services, Llc | |
|
4410 Claiborne Sq E Suite 200 Hampton VA 23666-2071 | |
| (804) 353-2397 | |
| (804) 353-2022 |
| Full Name | Changing Faces Youth Services, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4410 Claiborne Sq E, Hampton, Virginia |
| Authorized Official Name and Position | Raymond Dorsey (CHIEF EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8044791184 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Changing Faces Youth Services, Llc 1413 Idlewood Ave Richmond VA 23220-6003 Ph: (804) 353-2397 | Changing Faces Youth Services, Llc 4410 Claiborne Sq E Suite 200 Hampton VA 23666-2071 Ph: (804) 353-2397 |
| NPI Number | 1790080760 |
|---|---|
| Provider Enumeration Date | 01/21/2011 |
| Last Update Date | 01/21/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790080760 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1403-05-001 (Virginia) | Primary |
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