NPIMap

Organization Active NPI

Youth and Family Dynamics Mental Health Support, LLC

  • Community/Behavioral Health Agency
  • Henrico, VA
National Provider Identifier
1013210178
Registry record updated Dec 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
1162 Issued in VA
Legal business name
YOUTH AND FAMILY DYNAMICS MENTAL HEALTH SUPPORT, LLC
Practice address
5741 S Laburnum Ave
Suite #111
Henrico, VA 23231-4431
Phone
(804) 477-3065
Fax
(804) 477-3092
NPI assigned
Dec 13, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Allen F. Jackson Jr., BS
Title
Cheif Executive Officer
Phone
(804) 477-3065

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 1162 VA Primary

Addresses

Primary practice location

5741 S Laburnum Ave
Suite #111
Henrico, VA 23231-4431

Mailing address

1733 First Colonial CT
Henrico, VA 23231-6892
Phone (804) 501-9440

National Provider Directory

National Provider Directory

Locations

5741 S Laburnum Ave
Ste 111
Henrico, VA 23231
Phone (804) 477-3065

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1292198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386028800000",
    "number": "1013210178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1733 FIRST COLONIAL CT",
            "city": "HENRICO",
            "state": "VA",
            "postal_code": "232316892",
            "telephone_number": "804-501-9440",
            "fax_number": "804-222-8122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5741 S LABURNUM AVE",
            "address_2": "SUITE #111",
            "city": "HENRICO",
            "state": "VA",
            "postal_code": "232314431",
            "telephone_number": "804-477-3065",
            "fax_number": "804-477-3092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUTH AND FAMILY DYNAMICS MENTAL HEALTH SUPPORT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-13",
        "last_updated": "2013-12-03",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "ALLEN",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "CHEIF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "804-477-3065",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "BS"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "VA",
            "license": "1162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henrico, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.