Provider Demographics
NPI:1457675308
Name:CENTER FOR YOUTH DEVELOPMENT, LLC
Entity Type:Organization
Organization Name:CENTER FOR YOUTH DEVELOPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:TOOLE-ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-598-1515
Mailing Address - Street 1:6409 FAYETTEVILLE RD # 120-368
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6297
Mailing Address - Country:US
Mailing Address - Phone:919-598-1515
Mailing Address - Fax:919-598-9725
Practice Address - Street 1:2515 NC HWY 55
Practice Address - Street 2:SUITE A & D
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-1374
Practice Address - Country:US
Practice Address - Phone:919-598-1515
Practice Address - Fax:919-598-9725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-032-447251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health