Provider Demographics
NPI:1104649664
Name:ROYAL, YANIASIA ENJOLI DAWN
Entity type:Individual
Prefix:
First Name:YANIASIA
Middle Name:ENJOLI DAWN
Last Name:ROYAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BLUEBILL DR APT 301
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-4808
Mailing Address - Country:US
Mailing Address - Phone:910-778-4106
Mailing Address - Fax:
Practice Address - Street 1:8910 DEEP BRANCH RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-7999
Practice Address - Country:US
Practice Address - Phone:910-671-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool