Organization
SPECIALIZED YOUTH SERVICES OF VA, INC
Active
Other names
Child and Family Guidance
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WARREN GIBSON BULL CEO (CHEIF EXECUTIVE OFFICER)
(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
328
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010026725
—
VA
05
—
010048621
—
VA
Enumeration date
11/09/2006
Last updated
04/01/2009
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