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General NPI Number Information
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NPI Number | 1780987057
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Entity Type | Organization
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Legal Business Name | YOUTH AGAINST SUBSTANCE ABUSE, INC
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Dates
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Enumeration Date | 12/08/2010
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Last Update Date | 12/08/2010
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Provider Practice Location Address
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Address Line | 5004 BRIAR OAKS CIRCLE
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City | ORLANDO
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State | FL
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Zip | 32808-1708
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Country | US
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Telephone | 407-970-8019
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Fax | 407-578-3094
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Provider Business Mailing Address
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Address Line | 5004 BRIAR OAKS CIRCLE
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City | ORLANDO
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State | FL
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Zip | 32808-1708
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Country | US
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Telephone | 407-970-8019
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Fax | 407-578-3094
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Authorized Official
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Title or Position | DIRECTOR/TARGET CASE MANGHAM
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Name | MS. VONZELIA PICKETT MANGHAM
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Credential | BSW/TCM
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Telephone | 407-970-8019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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