Organization
KEY INDEPENDENT DEVELOPMENT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MALCOLM ISAIAH MOODY MPA, B.S. (PROGRAM DIRECTOR)
(804) 909-1762
Entity
Organization
Contact information
Practice address
509 N HENRY ST, RICHMOND, VA 23220-3924
(804) 909-1762
Mailing address
509 N HENRY ST, RICHMOND, VA 23220-3924
(804) 909-1762
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
2105
VA
Other
Enumeration date
07/17/2013
Last updated
07/17/2013
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