Provider Demographics
NPI:1992977797
Name:YOUTH DIVERSITY COALTION
Entity type:Organization
Organization Name:YOUTH DIVERSITY COALTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLANA
Authorized Official - Middle Name:JEFFRIES
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:703-371-0946
Mailing Address - Street 1:2916 VALLEY SIDE TER
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-1163
Mailing Address - Country:US
Mailing Address - Phone:804-228-3729
Mailing Address - Fax:
Practice Address - Street 1:8025 HILLCREEK DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-6847
Practice Address - Country:US
Practice Address - Phone:703-371-0946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VASS22307320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness