| The Youth Academy, Inc. | |
|
237 Lela Harrison Rd Kingstree SC 29556-6771 | |
| (843) 382-5927 | |
| (843) 382-5826 |
| Full Name | The Youth Academy, Inc. |
|---|---|
| Speciality | Counselor - Professional |
| Location | 237 Lela Harrison Rd, Kingstree, South Carolina |
| Authorized Official Name and Position | Daphne Wilson Boston (EXECUTIVE DIRECTOR / LCS) |
| Authorized Official Contact | 8433825927 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Youth Academy, Inc. 237 Lela Harrison Rd Po Box 174 Kingstree SC 29556-6771 Ph: (843) 382-5927 | The Youth Academy, Inc. 237 Lela Harrison Rd Kingstree SC 29556-6771 Ph: (843) 382-5927 |
| NPI Number | 1073562211 |
|---|---|
| Provider Enumeration Date | 05/07/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073562211 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | SR-0008158001-CCI (South Carolina) | Secondary |
| 101YP2500X | Counselor - Professional | SR-0001723001-GH (South Carolina) | Primary |
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