Healthcare Provider Details

I. General information

NPI: 1427295591
Provider Name (Legal Business Name): LEE COUNTY YOUTH DEVELOPMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 SPRING DR
OPELIKA AL
36801-5345
US

IV. Provider business mailing address

1109 SPRING DR
OPELIKA AL
36801-5345
US

V. Phone/Fax

Practice location:
  • Phone: 334-749-2996
  • Fax: 334-745-0503
Mailing address:
  • Phone: 334-749-2996
  • Fax: 334-745-0503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number StateAL

VIII. Authorized Official

Name: LAURA J COOPER
Title or Position: EXECUTIVE DIRECTOR
Credential: M.ED.
Phone: 334-749-2996