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General NPI Number Information
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NPI Number | 1730495482
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Entity Type | Organization
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Legal Business Name | YOUTH EXCEL AND ADVANCEMENT, LLC
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Dates
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Enumeration Date | 08/19/2010
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Last Update Date | 08/19/2010
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Provider Practice Location Address
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Address Line | 4222 BONNIEBANK RD SUITE 101
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City | RICHMOND
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State | VA
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Zip | 23234-6602
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Country | US
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Telephone | 804-986-7036
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Fax | 804-303-8657
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Provider Business Mailing Address
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Address Line | 4222 BONNIEBANK RD STE 101
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City | RICHMOND
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State | VA
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Zip | 23234-6633
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Country | US
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Telephone | 804-986-7036
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Fax | 804-303-8657
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Authorized Official
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Title or Position | OWNER
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Name | MARIO ONEAL HASKETT SR.
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Credential | BA, SOCIOLOGY
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Telephone | 804-986-7036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management 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 | 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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