Organization
YOUTH AND FAMILY DYNAMICS DAY TREATMENT SUPPORT,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALLEN F JACKSON JR. (CHEIF EXECUTIVE OFFICER/LLC)
(804) 501-9440
Entity
Organization
Contact information
Practice address
5741 S LABURNUM AVE, HENRICO, VA 23231-4431
(804) 501-9440
Mailing address
1733 FIRST COLONIAL CT, HENRICO, VA 23231-6892
(804) 501-9440
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1162-02-030
VA
Other
Enumeration date
12/16/2009
Last updated
12/03/2013
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