Provider Demographics
NPI:1790013696
Name:MINOR, YOLANDE M (EDD)
Entity Type:Individual
Prefix:DR
First Name:YOLANDE
Middle Name:M
Last Name:MINOR
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7232 LORENE LN
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-2516
Mailing Address - Country:US
Mailing Address - Phone:678-906-5598
Mailing Address - Fax:678-906-5598
Practice Address - Street 1:316 ALEXANDER ST SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8217
Practice Address - Country:US
Practice Address - Phone:770-456-5655
Practice Address - Fax:770-573-7316
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA166174103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst