Organization
THE OLIVIA TAYLOR HOUSE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
T'ANDREA LENON GRAHAM MSW SOCIAL; B.S. PSY (EXECUTIVE DIRECTOR/OWNER)
(804) 605-6146
Entity
Organization
Contact information
Practice address
628 OLD WAGNER RD, PETERSBURG, VA 23805-9319
(804) 605-6146
Mailing address
628 OLD WAGNER RD, PETERSBURG, VA 23805-9319
(804) 605-6146
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/13/2021
Last updated
01/13/2021
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