Basic Information
| Provider Information | |||||||||
| NPI: | 1871886929 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YOUTH HAVEN SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 229 TURNER DR | ||||||||
| Address2: | |||||||||
| City: | REIDSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273205736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363492233 | ||||||||
| FaxNumber: | 3366340444 | ||||||||
| Practice Location | |||||||||
| Address1: | 2815 S CHURCH ST UNIT 100 | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272155105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365860647 | ||||||||
| FaxNumber: | 3365860729 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2011 | ||||||||
| LastUpdateDate: | 11/14/2017 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | DAWN | ||||||||
| AuthorizedOfficialMiddleName: | TUCKER | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3363492233 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.