Specialized Youth Services of VA, Inc

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

328 Issued in VA

Legal business name

SPECIALIZED YOUTH SERVICES OF VA, INC

Doing business as

Child and Family Guidance

Practice address

230 S Crater Rd
Petersburg, VA 23803-4424

Phone

(804) 733-2180

Fax

(804) 733-8502

NPI assigned

Nov 9, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Warren Gibson Bull, CEO

Title

Cheif Executive Officer

Phone

(804) 733-2180

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Child and Family Guidance Doing business as

Tax ID family

Child and Family Guidance2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Specialized Youth Services of VA, Inc

  • Mental Health Counselor
  • Petersburg, VA
  • NPI 1811022361
  NPD tax ID

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238544000000",
    "number": "1366513715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 S CRATER RD",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238034424",
            "telephone_number": "804-733-2180",
            "fax_number": "804-733-8502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 S CRATER RD",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238034424",
            "telephone_number": "804-733-2180",
            "fax_number": "804-733-8502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALIZED YOUTH SERVICES OF VA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2009-04-01",
        "status": "A",
        "authorized_official_last_name": "BULL",
        "authorized_official_first_name": "WARREN",
        "authorized_official_middle_name": "GIBSON",
        "authorized_official_title_or_position": "CHEIF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "804-733-2180",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": "328",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010026725",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010048621",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Child and Family Guidance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Specialized Youth Services of VA, Inc
• Heather N. Spivey, MSW, LCSW, CSAC
• Spring Oak Assisted Living at Petersburg
• Spring of Hope Therapeutic Services, LLC
• Edde Karen Springer, CRNA

• Mental Health Counselor in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Mental Health Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2009; 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.