Organization Name: | NATIONAL YOUTH ADVOCATE PROGRAM |
NPI Number: | 1205245081 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARVENA TWIGG (PRESIDENT/CEO) |
Mailing Address: | 732 Wabash St Michigan City |
State: | IN US |
Postal Code: | 463603418 |
Phone Number: | 2192216068 |
Fax Number: | 2192938616 |
NPI Enumeration Date: | 08/06/2014 |
NPI Last Update Date: | 08/06/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |