Provider Demographics
NPI:1932855277
Name:YANKU, ILANA BROOKE (LCSW, LCASA)
Entity Type:Individual
Prefix:MS
First Name:ILANA
Middle Name:BROOKE
Last Name:YANKU
Suffix:
Gender:F
Credentials:LCSW, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 EXECUTIVE CENTER DR STE 111
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-8880
Mailing Address - Country:US
Mailing Address - Phone:704-537-1202
Mailing Address - Fax:
Practice Address - Street 1:5855 EXECUTIVE CENTER DR STE 111
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8880
Practice Address - Country:US
Practice Address - Phone:704-537-1202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-26894101YA0400X
NCC0151131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)