Provider Demographics
NPI:1215288071
Name:YOUTH DEVELOPMENT COUNSELING AGENCY
Entity type:Organization
Organization Name:YOUTH DEVELOPMENT COUNSELING AGENCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:MOSTAFA
Authorized Official - Last Name:ABDELMAGID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-252-4118
Mailing Address - Street 1:5209 NINE MILE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-3313
Mailing Address - Country:US
Mailing Address - Phone:804-252-4118
Mailing Address - Fax:804-200-5561
Practice Address - Street 1:5209 NINE MILE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-3313
Practice Address - Country:US
Practice Address - Phone:804-252-4118
Practice Address - Fax:804-200-5561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1492251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health