Provider Demographics
NPI:1134857337
Name:YOLO THERAPY LLC
Entity type:Organization
Organization Name:YOLO THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR-MCCUNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-530-9790
Mailing Address - Street 1:PO BOX 682
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20718-0682
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:404-595-8805
Practice Address - Street 1:2997 COBB PKWY SE UNIT 724324
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:31139-2652
Practice Address - Country:US
Practice Address - Phone:404-530-9790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-15
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC090493455Medicaid
GA003288944AMedicaid