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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