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General NPI Number Information
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NPI Number | 1063322139
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Entity Type | Organization
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Legal Business Name | NATIONAL YOUTH ADVOCATE PROGRAM, INC
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Dates
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Enumeration Date | 09/10/2026
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Last Update Date | 09/10/2026
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Provider Practice Location Address
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Address Line | 100 CRESCENT CENTER PKWY STE 680
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City | TUCKER
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State | GA
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Zip | 30084-7061
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Country | US
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Telephone | 404-761-7997
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 WATERMARK DR STE 200
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City | COLUMBUS
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State | OH
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Zip | 43215-7088
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SYSTEM ANALYST
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Name | KEVIN L CLUTS
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Credential |
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Telephone | 614-487-8758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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