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General NPI Number Information
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NPI Number | 1992016208
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Entity Type | Organization
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Legal Business Name | YOUTH HAVEN SERVICES, INC.
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Dates
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Enumeration Date | 07/01/2010
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 229 TURNER DR
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City | REIDSVILLE
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State | NC
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Zip | 27320-5736
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Country | US
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Telephone | 336-349-2233
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Fax | 336-634-0444
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Provider Business Mailing Address
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Address Line | 229 TURNER DR
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City | REIDSVILLE
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State | NC
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Zip | 27320-5736
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Country | US
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Telephone | 336-349-2233
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Fax | 336-634-0444
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Authorized Official
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Title or Position | CEO
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Name | DAWN TUCKER JOHNSON
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Credential |
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Telephone | 336-349-2233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health 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 | 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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