Provider Demographics
NPI:1013156942
Name:IT TAKES A VILLAGE YOUTH AND FAMILY SERVICES
Entity Type:Organization
Organization Name:IT TAKES A VILLAGE YOUTH AND FAMILY SERVICES
Other - Org Name:IT TAKES A VILLAGE YOUTH AND FAMILY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:980-819-7448
Mailing Address - Street 1:5736 N TRYON ST
Mailing Address - Street 2:SUITE 105, 116
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-6850
Mailing Address - Country:US
Mailing Address - Phone:980-819-7448
Mailing Address - Fax:980-819-7449
Practice Address - Street 1:5736 N TRYON ST
Practice Address - Street 2:SUITE 105,116
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-6850
Practice Address - Country:US
Practice Address - Phone:980-819-7448
Practice Address - Fax:980-819-7449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NC261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No251S00000XAgenciesCommunity/Behavioral Health