Provider Demographics
NPI:1316138795
Name:AKC YOUTH SERVICES
Entity type:Organization
Organization Name:AKC YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:BA,,QP
Authorized Official - Phone:704-994-9411
Mailing Address - Street 1:201 W MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170
Mailing Address - Country:US
Mailing Address - Phone:704-994-9411
Mailing Address - Fax:704-994-3588
Practice Address - Street 1:1205 CAMDEN RD
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170
Practice Address - Country:US
Practice Address - Phone:704-994-9411
Practice Address - Fax:704-994-3588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X
NC305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No305R00000XManaged Care OrganizationsPreferred Provider Organization