Organization
ATIBA YOUTH INTERVENTION SERVICES-DANVILLE, LLC
Active
Parent organization
ATIBA YOUTH INTERVENTION SERVICES, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
ATIBA YOUTH INTERVENTION SERVICES, LLC
Authorized official
MR. DONALD A WHEELER BA, AAS, QMHP (EXECUTIVE DIRECTOR)
(804) 272-2277
Entity
Organization
Contact information
Practice address
7825 MIDLOTHIAN TPKE STE 112, NORTH CHESTERFIELD, VA 23235-5247
(804) 272-2277
Mailing address
7825 MIDLOTHIAN TPKE STE 112, NORTH CHESTERFIELD, VA 23235-5247
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1181
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477719144
—
VA
Enumeration date
09/26/2011
Last updated
09/26/2011
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