Healthcare Provider Details

I. General information

NPI: 1407901689
Provider Name (Legal Business Name): YOUTH UNLIMITED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 BURTON AVE
HIGH POINT NC
27262-8070
US

IV. Provider business mailing address

PO BOX 485
HIGH POINT NC
27261-0485
US

V. Phone/Fax

Practice location:
  • Phone: 336-883-1361
  • Fax: 336-883-0065
Mailing address:
  • Phone: 336-883-1361
  • Fax: 336-883-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. R CLIFFORD PARKERS JR.
Title or Position: EX DIRECTOR
Credential: LPC
Phone: 336-883-1361