Organization
YOUTH AND FAMILY DYNAMICS MENTAL HEALTH SUPPORT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALLEN F. JACKSON JR. BS (CHEIF EXECUTIVE OFFICER)
(804) 477-3065
Entity
Organization
Contact information
Practice address
5741 S LABURNUM AVE, SUITE #111, HENRICO, VA 23231-4431
(804) 477-3065
(804) 477-3092
Mailing address
1733 FIRST COLONIAL CT, HENRICO, VA 23231-6892
(804) 501-9440
(804) 222-8122
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1162
VA
Other
Enumeration date
12/13/2010
Last updated
12/03/2013
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