Provider Demographics
NPI:1497227177
Name:YOUTH OF PROMISE
Entity Type:Organization
Organization Name:YOUTH OF PROMISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYMMOLLOTKIS
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:YANCEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-445-1381
Mailing Address - Street 1:6308 HOT SPRING LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-2577
Mailing Address - Country:US
Mailing Address - Phone:540-322-7751
Mailing Address - Fax:
Practice Address - Street 1:6308 HOT SPRING LN
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-2577
Practice Address - Country:US
Practice Address - Phone:540-322-7751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health