Specialized Youth Services of VA, Inc

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

SPECIALIZED YOUTH SERVICES OF VA, INC

Practice address

230 S Crater Rd
Petersburg, VA 23803-4424

Phone

(804) 733-2180

Fax

(804) 733-8502

NPI assigned

Feb 23, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Warren G Bull, CEO

Title

Owner

Phone

(804) 733-2180

Specialties & licenses 3

Addresses

Other identifiers 1

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 1366513715
  NPD tax ID

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192406400000",
    "number": "1811022361",
    "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": "2007-02-23",
        "last_updated": "2007-10-15",
        "status": "A",
        "authorized_official_last_name": "BULL",
        "authorized_official_first_name": "WARREN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "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": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1780872101",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southside Specialists for Women, P.C.
• Southside Virginia Emergency Crew,Inc.
• Southside Virginia Training Center
• Southside Virginia Traninng Center
• 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
• Susan E St George, DDS

• 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 Oct 15, 2007; 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.