Provider Demographics
NPI:1336765262
Name:VALLEY YOUTH SUBSTANCE ABUSE CENTER
Entity Type:Organization
Organization Name:VALLEY YOUTH SUBSTANCE ABUSE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BS
Authorized Official - Prefix:
Authorized Official - First Name:SHINAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BEST
Authorized Official - Suffix:
Authorized Official - Credentials:BIOLOGY
Authorized Official - Phone:252-676-9982
Mailing Address - Street 1:804 MELVIN RD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NC
Mailing Address - Zip Code:27850-8787
Mailing Address - Country:US
Mailing Address - Phone:252-676-9982
Mailing Address - Fax:
Practice Address - Street 1:1445 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4653
Practice Address - Country:US
Practice Address - Phone:252-676-9982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNAMedicaid