Provider Demographics
NPI:1134498934
Name:NATIONAL YOUTH ADVOCATE PROGRAM
Entity Type:Organization
Organization Name:NATIONAL YOUTH ADVOCATE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARVENA
Authorized Official - Middle Name:
Authorized Official - Last Name:TWIGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-202-2965
Mailing Address - Street 1:1801 WATERMARK DR
Mailing Address - Street 2:STE 200
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-7088
Mailing Address - Country:US
Mailing Address - Phone:888-202-2965
Mailing Address - Fax:614-487-8759
Practice Address - Street 1:56 E MCCLAIN AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-1844
Practice Address - Country:US
Practice Address - Phone:800-381-9673
Practice Address - Fax:812-752-9894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)