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General NPI Number Information
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NPI Number | 1578189940
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Entity Type | Organization
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Legal Business Name | YOUR DISCOVERY PLACE INC
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Dates
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Enumeration Date | 06/22/2020
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 3911 S LANCASTER RD STE 100
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City | DALLAS
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State | TX
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Zip | 75216-5682
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Country | US
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Telephone | 855-207-0596
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Fax |
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Provider Business Mailing Address
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Address Line | 3911 S LANCASTER RD STE 100
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City | DALLAS
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State | TX
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Zip | 75216-5682
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Country | US
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Telephone | 855-207-0596
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. CHEVELLA JOYNELL CAMPBELL
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Credential | LCDC
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Telephone | 469-251-9201
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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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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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