Organization
DOMINION WAIVER SERVICES
Active
Parent organization
DOMINION YOUTH SERVICES
Organization subpart
Yes
Provider details
NPI number
Legal business name
DOMINION YOUTH SERVICES
Authorized official
MR. GL PULLIAM JR. MS (DIRECTOR OF RESIDENTIAL)
(804) 285-9838
Entity
Organization
Contact information
Practice address
1002 WILMER AVE, RICHMOND, VA 23227-2403
(804) 266-9012
(804) 266-9022
Mailing address
PO BOX 70296, RICHMOND, VA 23255-0296
(804) 285-9838
(804) 285-9839
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
40608011
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
406-08-011
DMHMRSAS LICENSE NUMBER
VA
Enumeration date
11/18/2008
Last updated
11/18/2008
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