| Edgewood Group Family Services | |
|
4906 Fitzhugh Ave Suite 104 Richmond VA 23230-3526 | |
| (804) 648-0671 | |
| (804) 648-0672 |
| Full Name | Edgewood Group Family Services |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 4906 Fitzhugh Ave, Richmond, Virginia |
| Authorized Official Name and Position | William Travis Crocker (DIRECTOR OF SERVICES) |
| Authorized Official Contact | 8046480671 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Edgewood Group Family Services 4906 Fitzhugh Ave Suite 104 Richmond VA 23230-3526 Ph: (804) 648-0671 | Edgewood Group Family Services 4906 Fitzhugh Ave Suite 104 Richmond VA 23230-3526 Ph: (804) 648-0671 |
| NPI Number | 1881607414 |
|---|---|
| Provider Enumeration Date | 08/14/2006 |
| Last Update Date | 02/17/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881607414 | NPI | - | NPPES |
| 010127394 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 709-05-001 (Virginia) | Primary |
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