Provider Demographics
NPI:1073951281
Name:YOUTH UNLIMITED INC
Entity Type:Organization
Organization Name:YOUTH UNLIMITED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EX DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:R
Authorized Official - Middle Name:CLIFFORD
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:336-883-1361
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27261-0485
Mailing Address - Country:US
Mailing Address - Phone:336-883-1361
Mailing Address - Fax:
Practice Address - Street 1:2962 YOUTH UNLIMITED DR
Practice Address - Street 2:
Practice Address - City:SOPHIA
Practice Address - State:NC
Practice Address - Zip Code:27350-8481
Practice Address - Country:US
Practice Address - Phone:336-861-9243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101Y00000X, 251S00000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300354GMedicaid
NC5907794Medicaid
NC8300347GMedicaid
NC6005364Medicaid
NC8300354HMedicaid
NC3410056Medicaid
NC8300347HMedicaid