Provider Demographics
NPI:1801629951
Name:POSITIVE IMPACT MENTORING
Entity type:Organization
Organization Name:POSITIVE IMPACT MENTORING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUJUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG-BATTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-485-6092
Mailing Address - Street 1:4213 PAPPY KENNEDY ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-4672
Mailing Address - Country:US
Mailing Address - Phone:407-485-6092
Mailing Address - Fax:
Practice Address - Street 1:4213 PAPPY KENNEDY ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-4672
Practice Address - Country:US
Practice Address - Phone:407-485-6092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health