Organization
DOMINION ABA
Active
Parent organization
DOMINION YOUTH SERVICES RESIDENTIAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
DOMINION YOUTH SERVICES RESIDENTIAL
Authorized official
MR. GEORGE PULLIAM JR. MS (DIRECTOR)
(804) 285-9838
Entity
Organization
Contact information
Practice address
5408 CHAMBERLAYNE RD, RICHMOND, VA 23227-2407
(804) 285-9838
(804) 285-9839
Mailing address
5408 CHAMBERLAYNE RD, RICHMOND, VA 23227-2407
(804) 285-9838
(804) 285-9839
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1654-07-004
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1654-07-004
—
VA
Enumeration date
05/16/2012
Last updated
05/16/2012
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