Organization
HAMPTON ROADS YOUTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DENISE RAE MULLINS LCSW, CSAC (CHIEF EXECUTIVE OFFICER)
(757) 923-4948
Entity
Organization
Contact information
Practice address
275 KENYON RD, SUITE A, SUFFOLK, VA 23434-7450
(757) 923-4948
(757) 923-4949
Mailing address
275 KENYON RD, SUFFOLK, VA 23434-7450
(757) 923-4948
(757) 923-4949
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
SS-241-06
VA
Other
Enumeration date
10/26/2007
Last updated
11/06/2007
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