Provider Demographics
NPI:1154195956
Name:REGULATE YOUTH THERAPY LLC
Entity type:Organization
Organization Name:REGULATE YOUTH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA DRIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ETIENNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-551-3646
Mailing Address - Street 1:8228 MARSHALL BRIDGE RD APT 4108
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6768
Mailing Address - Country:US
Mailing Address - Phone:678-551-3646
Mailing Address - Fax:
Practice Address - Street 1:601 N POLK ST STE L
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-7472
Practice Address - Country:US
Practice Address - Phone:678-551-3646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty