Provider Demographics
NPI:1063007433
Name:YOUTH EMPOWERMENT SUPPORT SERVICES LLC
Entity Type:Organization
Organization Name:YOUTH EMPOWERMENT SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:TYNIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:COBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-359-0420
Mailing Address - Street 1:PO BOX 1531
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-1531
Mailing Address - Country:US
Mailing Address - Phone:443-359-0420
Mailing Address - Fax:
Practice Address - Street 1:9085 MITCHELL RD
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-2862
Practice Address - Country:US
Practice Address - Phone:301-636-7010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-07
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Multi-Specialty