Provider Demographics
NPI:1780013714
Name:UNIQUE INTERVENTIONS FOR YOUTH
Entity Type:Organization
Organization Name:UNIQUE INTERVENTIONS FOR YOUTH
Other - Org Name:UNIQUE INTERVENTIONS FOR YOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EX. DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-201-2185
Mailing Address - Street 1:1303 MAIN ST
Mailing Address - Street 2:SUITE 413
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-3464
Mailing Address - Country:US
Mailing Address - Phone:803-201-2185
Mailing Address - Fax:
Practice Address - Street 1:1303 MAIN ST
Practice Address - Street 2:SUITE 413
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-3464
Practice Address - Country:US
Practice Address - Phone:803-201-2185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251S00000XAgenciesCommunity/Behavioral Health