Provider Demographics
NPI:1801225388
Name:YOLANDA DUBOSE WOMAN SURVIVAL FOUNDATION LLC
Entity Type:Organization
Organization Name:YOLANDA DUBOSE WOMAN SURVIVAL FOUNDATION LLC
Other - Org Name:WOMAN SURVIVAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBOSE
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:203-859-0313
Mailing Address - Street 1:105 W PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-3540
Mailing Address - Country:US
Mailing Address - Phone:203-859-0313
Mailing Address - Fax:
Practice Address - Street 1:105 W PROSPECT ST
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-3540
Practice Address - Country:US
Practice Address - Phone:203-859-0313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT251S00000X, 261QM0850X, 320800000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility