MEDICARE: POSITIVE YOUTH REINFORCEMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1043483233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITIVE YOUTH REINFORCEMENT

Provider Business Mailing Address
First Line	:	2131 WOODRUFF RD
Second Line	:	SUITE # 2100 #292
City	:	GREENVILLE
State	:	SC
Zip	:	29607-5950
Country	:	US
Telephone Number	:	864-444-3057
Fax Number	:

Provider Business Practice Location Address
First Line	:	2131 WOODRUFF RD
Second Line	:	SUITE # 2100 #292
City	:	GREENVILLE
State	:	SC
Zip	:	29607-5950
Country	:	US
Telephone Number	:	864-444-3057
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. SUNTIA LAMEKA SMITH
Credential	:	MSW
Telephone Number	:	864-444-3057

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	04/08/2008

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Directions to “POSITIVE YOUTH REINFORCEMENT ” Practice Location

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