Provider Demographics
NPI:1801911276
Name:TRI-COUNTY YOUTH SERVICES, INC.
Entity type:Organization
Organization Name:TRI-COUNTY YOUTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-616-7173
Mailing Address - Street 1:PO BOX 692
Mailing Address - Street 2:
Mailing Address - City:WALLACE
Mailing Address - State:NC
Mailing Address - Zip Code:28466-0692
Mailing Address - Country:US
Mailing Address - Phone:910-285-6099
Mailing Address - Fax:910-285-6321
Practice Address - Street 1:410 E CAVENAUGH ST
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466-1908
Practice Address - Country:US
Practice Address - Phone:910-285-6099
Practice Address - Fax:910-285-6321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-031-041261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301164Medicaid
NC8301164BMedicaid