Provider Demographics
NPI:1528296159
Name:UNITED METHODIST FAMILY SERVICES
Entity type:Organization
Organization Name:UNITED METHODIST FAMILY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADALAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-490-9791
Mailing Address - Street 1:5301 ROBIN HOOD RD STE 122
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-2419
Mailing Address - Country:US
Mailing Address - Phone:757-490-9791
Mailing Address - Fax:757-490-8324
Practice Address - Street 1:5301 ROBIN HOOD RD STE 122
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-2419
Practice Address - Country:US
Practice Address - Phone:757-490-9791
Practice Address - Fax:757-490-8324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA19305001101YP2500X
VACO5209253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253J00000XAgenciesFoster Care Agency
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA000200085Medicaid