# STARTING POINT

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124107966
- **Authorized official:** MS. JACKIE C. WOODLEY (PROGRAM DIRECTOR)
- **Authorized official phone:** (804) 756-0159

## Contact information

- **Practice address:** 10556 COURTNEY RD, GLEN ALLEN, VA 23060-3011
- **Practice address phone:** (804) 756-0159
- **Practice address fax:** (804) 756-0159
- **Mailing address:** 10556 COURTNEY RD, GLEN ALLEN, VA 23060-3011
- **Mailing address phone:** (804) 756-0159
- **Mailing address fax:** (804) 756-0159

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 11/03/2006
- **Last updated:** 08/22/2020
