Organization
CHANGING FACES YOUTH SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAYMOND DORSEY (CHIEF EXECUTIVE DIRECTOR)
(804) 479-1184
Entity
Organization
Contact information
Practice address
4410 CLAIBORNE SQ E, SUITE 200, HAMPTON, VA 23666-2071
(804) 353-2397
(804) 353-2022
Mailing address
1413 IDLEWOOD AVE, RICHMOND, VA 23220-6003
(804) 353-2397
(804) 353-2022
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1403-05-001
VA
Other
Enumeration date
01/21/2011
Last updated
01/21/2011
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