Provider Demographics
NPI:1588704589
Name:GOOD WORKS YOUTH AND ADULT SERVICES, INC.
Entity type:Organization
Organization Name:GOOD WORKS YOUTH AND ADULT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LA TANYA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, QP
Authorized Official - Phone:704-780-8713
Mailing Address - Street 1:4919 ALBEMARLE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-6683
Mailing Address - Country:US
Mailing Address - Phone:704-405-1251
Mailing Address - Fax:704-405-1254
Practice Address - Street 1:4919 ALBEMARLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6683
Practice Address - Country:US
Practice Address - Phone:704-405-1251
Practice Address - Fax:704-405-1254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301753Medicaid