Basic Information
| Provider Information | |||||||||
| NPI: | 1952661183 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NATIONAL YOUTH ADVOCATE PROGRAM, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 WATERMARK DR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432157088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144878758 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1303 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432052047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002565001 | ||||||||
| FaxNumber: | 6142524367 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2012 | ||||||||
| LastUpdateDate: | 05/22/2012 | ||||||||
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| AuthorizedOfficialLastName: | TWIGG | ||||||||
| AuthorizedOfficialFirstName: | MARVENA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6144878758 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | OH | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.