Provider Demographics
NPI:1154622389
Name:YOUTH ENRICHMENT SERVICES OF LKN, INC
Entity type:Organization
Organization Name:YOUTH ENRICHMENT SERVICES OF LKN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-660-0973
Mailing Address - Street 1:635 W MCLELLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-3140
Mailing Address - Country:US
Mailing Address - Phone:704-660-0973
Mailing Address - Fax:
Practice Address - Street 1:635 W MCLELLAND AVE
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-3140
Practice Address - Country:US
Practice Address - Phone:704-660-0973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty