Healthcare Provider Details

I. General information

NPI: 1881009405
Provider Name (Legal Business Name): YAVA ADDICTION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13055 NW 42ND STREET STE 208
MIAMI FL
33175-3410
US

IV. Provider business mailing address

13055 NW 42ND STREET STE 208
MIAMI FL
33175-3410
US

V. Phone/Fax

Practice location:
  • Phone: 305-225-3108
  • Fax: 305-225-3109
Mailing address:
  • Phone: 305-225-3108
  • Fax: 305-225-3109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: VANESSA LAGO
Title or Position: PRESIDENT/CEO
Credential:
Phone: 305-225-3108