| Youth Life Services, Llc | |
|
307 Lafayette Blvd Ste 300 Fredericksburg VA 22401-6066 | |
| (540) 210-7624 | |
| Not Available |
| Full Name | Youth Life Services, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 307 Lafayette Blvd Ste 300, Fredericksburg, Virginia |
| Authorized Official Name and Position | Antaysia Thomas (PRESIDENT) |
| Authorized Official Contact | 5402107624 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Youth Life Services, Llc 10908 Courthouse Rd Ste 102149 Fredericksburg VA 22408-2658 Ph: (540) 210-7624 | Youth Life Services, Llc 307 Lafayette Blvd Ste 300 Fredericksburg VA 22401-6066 Ph: (540) 210-7624 |
| NPI Number | 1194331918 |
|---|---|
| Provider Enumeration Date | 09/17/2020 |
| Last Update Date | 10/13/2023 |
| Certification Date | 10/13/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194331918 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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