Provider Demographics
NPI:1962859496
Name:YOUR CENTER, LLC
Entity Type:Organization
Organization Name:YOUR CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAKEETRA
Authorized Official - Middle Name:MCCLAINE
Authorized Official - Last Name:JOSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, APRN
Authorized Official - Phone:215-806-5111
Mailing Address - Street 1:1 WHITE OAK RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-3264
Mailing Address - Country:US
Mailing Address - Phone:302-298-3818
Mailing Address - Fax:302-761-9273
Practice Address - Street 1:222 PHILADELPHIA PIKE STE 4
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-3166
Practice Address - Country:US
Practice Address - Phone:302-298-3818
Practice Address - Fax:888-801-2676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2015607417261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)