NPI 1952562811

Dominion Youth Services

Organisation Mental Illness Community Based Residential Treatment Facility Roanoke, VA

Practice location

Address: 4802 Northridge Lane, Roanoke, VA 24019
Phone: (540) 366-3080
Fax: (540) 366-3081
Mailing address: 8401 Mayland Drive Suite C, Richmond, VA 23294

Authorised official

Name: Gl Pulliam
Title: Director of Residential
Phone: (804) 285-9838

Registered specialties

Mental Illness Community Based Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320800000X Licence 40614077 (VA)

Other Community Based Residential Treatment Facility, Mental Illness providers in Virginia →

Registry record

NPI: 1952562811
Entity type: Organization
NPI issued: 23 Jun 2008
Record last updated: 23 Jun 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.