Healthcare Provider Details

I. General information

NPI: 1346561370
Provider Name (Legal Business Name): YOUTH TRANSITIONAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2879 HIGHWAY 160 WEST STE. 4388
FORT MILL SC
29708-8581
US

IV. Provider business mailing address

2879 HIGHWAY 160 W STE. 4388
FORT MILL SC
29708-8581
US

V. Phone/Fax

Practice location:
  • Phone: 803-526-3288
  • Fax: 803-675-5233
Mailing address:
  • Phone: 803-526-3288
  • Fax: 803-675-5233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE DOLPHUS
Title or Position: OWNER/CEO
Credential:
Phone: 803-526-3288