MEDICARE: ALEXANDER YOUTH NETWORK

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	:	1811497639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEXANDER YOUTH NETWORK

Provider Business Mailing Address
First Line	:	6220 THERMAL RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-5630
Country	:	US
Telephone Number	:	704-366-8712
Fax Number	:	704-362-8464

Provider Business Practice Location Address
First Line	:	1608 CAMDEN RD
Second Line	:	ROOMS #16 & #17
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-1734
Country	:	US
Telephone Number	:	910-703-8791
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRENNON GRAHAM
Credential	:
Telephone Number	:	704-366-8712

Provider Enumeration Date	:	02/19/2018
Last Update Date	:	08/29/2025

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Directions to “ALEXANDER YOUTH NETWORK ” Practice Location

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