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Organization
SPECIALIZED YOUTH SERVICES OF VA, INC
Active
Organization
SPECIALIZED YOUTH SERVICES OF VA, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WARREN G BULL CEO (OWNER)
(804) 733-2180
Entity
Organization
Contact information
Practice address
230 S CRATER RD, PETERSBURG, VA 23803-4424
(804) 733-2180
(804) 733-8502
Mailing address
230 S CRATER RD, PETERSBURG, VA 23803-4424
(804) 733-2180
(804) 733-8502
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1780872101
NPI
VA
Enumeration date
02/23/2007
Last updated
10/15/2007
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