Provider Demographics
NPI:1588914824
Name:ADVANCING YOUTH'S ACADEMY, INC
Entity type:Organization
Organization Name:ADVANCING YOUTH'S ACADEMY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMMYS
Authorized Official - Middle Name:ALEMANIA
Authorized Official - Last Name:BELTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-650-0000
Mailing Address - Street 1:2662 HOLCOMB BRIDGE RD
Mailing Address - Street 2:SUITES 340, 328, 330
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-6819
Mailing Address - Country:US
Mailing Address - Phone:770-650-0000
Mailing Address - Fax:770-650-0002
Practice Address - Street 1:2662 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITES 340, 328, 330
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-6819
Practice Address - Country:US
Practice Address - Phone:770-650-0000
Practice Address - Fax:770-650-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA125325103T00000X, 101YA0400X
GAAPC002972101Y00000X, 103TB0200X
GA247200000X, 235Z00000X, 103TC2200X, 103TF0000X, 103TP2701X, 101YS0200X, 103TR0400X, 101YP1600X, 103TF0200X
261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Single Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Single Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA12471665OtherCAQH