Provider Demographics
NPI:1275699985
Name:GUILFORD YOUTH INITIATIVE, INC.
Entity Type:Organization
Organization Name:GUILFORD YOUTH INITIATIVE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:GRAHAM
Authorized Official - Last Name:REAVES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,CCAS,CCS
Authorized Official - Phone:336-884-8840
Mailing Address - Street 1:155 NORTHPOINT AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7738
Mailing Address - Country:US
Mailing Address - Phone:336-884-8840
Mailing Address - Fax:336-884-8842
Practice Address - Street 1:155 NORTHPOINT AVE
Practice Address - Street 2:STE 101
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7738
Practice Address - Country:US
Practice Address - Phone:336-884-8840
Practice Address - Fax:336-884-8842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-737101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005973Medicaid
NC6111908Medicaid
NC6110562Medicaid