Provider Demographics
NPI:1649516527
Name:NATIONAL YOUTH ADVOCATE PROGRAM
Entity type:Organization
Organization Name:NATIONAL YOUTH ADVOCATE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARVENA
Authorized Official - Middle Name:
Authorized Official - Last Name:TWIGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-688-9964
Mailing Address - Street 1:1801 WATERMARK DR
Mailing Address - Street 2:STE 200
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-7088
Mailing Address - Country:US
Mailing Address - Phone:888-688-9964
Mailing Address - Fax:614-487-3819
Practice Address - Street 1:2600 SANDCREST BLVD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3053
Practice Address - Country:US
Practice Address - Phone:812-342-4220
Practice Address - Fax:812-342-4250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-20
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)