Provider Demographics
NPI:1922344340
Name:ROSS, YULONDA (MS, LADAC, ICADC)
Entity Type:Individual
Prefix:
First Name:YULONDA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:MS, LADAC, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10515 W MARKHAM ST STE K5
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2287
Mailing Address - Country:US
Mailing Address - Phone:501-613-6542
Mailing Address - Fax:
Practice Address - Street 1:10515 W MARKHAM ST STE K5
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2287
Practice Address - Country:US
Practice Address - Phone:501-613-6542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1411-CADC101YA0400X
AR418L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116378726Medicaid