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General NPI Number Information
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NPI Number | 1912718669
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Entity Type | Organization
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Legal Business Name | NATIONAL YOUTH ADVOCATE PROGRAM
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 1820 RIDGE RD
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City | HOMEWOOD
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State | IL
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Zip | 60430-1760
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Country | US
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Telephone | 708-747-2655
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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 | 614-487-8758
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Fax | 614-487-8759
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MARVENA TWIGG
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Credential |
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Telephone | 888-202-2965
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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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