MEDICARE: YOUTH EMPOWERMENT SUCCESS SERVICES

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1619836814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUTH EMPOWERMENT SUCCESS SERVICES

Provider Business Mailing Address
First Line	:	1635 PHOENIX BLVD STE 7
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30349-5549
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1635 PHOENIX BLVD STE 7
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30349-5549
Country	:	US
Telephone Number	:	770-217-7845
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	EBONY HARRIS
Credential	:
Telephone Number	:	770-217-7845

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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Directions to “YOUTH EMPOWERMENT SUCCESS SERVICES ” Practice Location

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