Organization
STARTING POINT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JACKIE C. WOODLEY (PROGRAM DIRECTOR)
(804) 756-0159
Entity
Organization
Contact information
Practice address
10556 COURTNEY RD, GLEN ALLEN, VA 23060-3011
(804) 756-0159
(804) 756-0159
Mailing address
10556 COURTNEY RD, GLEN ALLEN, VA 23060-3011
(804) 756-0159
(804) 756-0159
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/03/2006
Last updated
08/22/2020
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