Provider Demographics
NPI:1215472568
Name:JAMES RIVER FAMILY SERVICES
Entity type:Organization
Organization Name:JAMES RIVER FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MALINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIFFANY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-836-9401
Mailing Address - Street 1:PO BOX 234
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23040-0234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1874 ANDERSON HWY BLDG C
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:VA
Practice Address - Zip Code:23040-2525
Practice Address - Country:US
Practice Address - Phone:434-414-4207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAMES RIVER THERAPEUTIC SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904008003251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health