Provider Demographics
NPI:1336395359
Name:ALTERNATIVE FAMILY TREATMENT SERVICES, INC
Entity type:Organization
Organization Name:ALTERNATIVE FAMILY TREATMENT SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY-HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, ACSW
Authorized Official - Phone:757-587-5615
Mailing Address - Street 1:7510 GRANBY ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-3437
Mailing Address - Country:US
Mailing Address - Phone:757-587-5615
Mailing Address - Fax:757-587-5639
Practice Address - Street 1:7510 GRANBY ST
Practice Address - Street 2:SUITE 6
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-3437
Practice Address - Country:US
Practice Address - Phone:757-587-5615
Practice Address - Fax:757-587-5639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA690-05-001251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services