Provider Demographics
NPI:1497418768
Name:ALEXANDER YOUTH NETWORK
Entity type:Organization
Organization Name:ALEXANDER YOUTH NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENNON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-366-8712
Mailing Address - Street 1:6220 THERMAL RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-5630
Mailing Address - Country:US
Mailing Address - Phone:704-366-8712
Mailing Address - Fax:
Practice Address - Street 1:2700 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-4003
Practice Address - Country:US
Practice Address - Phone:855-362-8470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-14
Last Update Date:2025-08-29
Deactivation Date:2025-06-03
Deactivation Code:
Reactivation Date:2025-08-06
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health