Provider Demographics
NPI:1457637316
Name:YOUTH & FAMILY ALLIANCE, INC.
Entity Type:Organization
Organization Name:YOUTH & FAMILY ALLIANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:910-251-5858
Mailing Address - Street 1:2600 NEW VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-7426
Mailing Address - Country:US
Mailing Address - Phone:910-251-5858
Mailing Address - Fax:910-251-5893
Practice Address - Street 1:2600 NEW VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-7426
Practice Address - Country:US
Practice Address - Phone:910-251-5858
Practice Address - Fax:910-251-5893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4195251E00000X
MH071-029251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6602133Medicaid
NC6008126Medicaid