Provider Demographics
NPI:1497986541
Name:PROMISING YOUTH, INC,
Entity Type:Organization
Organization Name:PROMISING YOUTH, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:QP
Authorized Official - Phone:704-509-0009
Mailing Address - Street 1:2750 E. W.T. HARRIS BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4285
Mailing Address - Country:US
Mailing Address - Phone:704-509-0009
Mailing Address - Fax:704-494-3555
Practice Address - Street 1:2750 EAST W.T.HARRIS BOULEVARD
Practice Address - Street 2:SUITE 105
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4285
Practice Address - Country:US
Practice Address - Phone:704-509-0009
Practice Address - Fax:704-494-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC178253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency