| Organization Name: | THE YOUTH ACADEMY, INC. |
| NPI Number: | 1073562211 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAPHNE WILSON BOSTON (EXECUTIVE DIRECTOR / LCS) |
| Mailing Address: | 237 Lela Harrison Rd Kingstree |
| State: | SC US |
| Postal Code: | 295566771 |
| Phone Number: | 8433825927 |
| Fax Number: | 8433825826 |
| NPI Enumeration Date: | 05/07/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | SR-0008158001-CCI |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | SC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |