| National Youth Advocate Program | |
|
1036 Speedway Avenue Suite 2 Fairmont WV 26554 | |
| (304) 363-4237 | |
| (304) 366-5863 |
| Full Name | National Youth Advocate Program |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1036 Speedway Avenue, Fairmont, West Virginia |
| Authorized Official Name and Position | Renee Ellenberger (EXECUTIVE DIRECTOR, WV) |
| Authorized Official Contact | 3043634237 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| National Youth Advocate Program 1036 Speedway Avenue Suite 2 Fairmont WV 26554 Ph: (304) 363-4237 | National Youth Advocate Program 1036 Speedway Avenue Suite 2 Fairmont WV 26554 Ph: (304) 363-4237 |
| NPI Number | 1336351469 |
|---|---|
| Provider Enumeration Date | 05/03/2007 |
| Last Update Date | 07/24/2023 |
| Certification Date | 07/24/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336351469 | NPI | - | NPPES |
| 0023630001 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 97 (West Virginia) | Primary |
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