Organization
LIFE YOUNG ADULT SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KEMBERLY LILES RAINNEY L.P.C., L.S.A.T.P. (VICE PRESIDENT/COO)
(804) 248-6964
Entity
Organization
Contact information
Practice address
3105 W MARSHALL ST, SUITE 208-212, RICHMOND, VA 23230-4729
(804) 658-1096
Mailing address
6013 MANOR HOUSE TRL, MOSELEY, VA 23120-2248
(804) 248-6964
(804) 279-0702
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
07/22/2010
Last updated
07/22/2010
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