Provider Demographics
NPI:1659589265
Name:YOUTH DEVELOPMENT CORPORATION OF AMERICA
Entity Type:Organization
Organization Name:YOUTH DEVELOPMENT CORPORATION OF AMERICA
Other - Org Name:GEORGIA SAFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEVELOPMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHREIBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-323-8081
Mailing Address - Street 1:6015 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6254
Mailing Address - Country:US
Mailing Address - Phone:919-323-8081
Mailing Address - Fax:919-572-0004
Practice Address - Street 1:105 FIELDSTONE DR
Practice Address - Street 2:SUITE 4
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-7107
Practice Address - Country:US
Practice Address - Phone:478-451-0775
Practice Address - Fax:478-451-0734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health