Provider Demographics
NPI:1992307466
Name:DR. YA LLC
Entity type:Organization
Organization Name:DR. YA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YANNICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LADSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LPC
Authorized Official - Phone:215-678-6206
Mailing Address - Street 1:PO BOX 255
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-0255
Mailing Address - Country:US
Mailing Address - Phone:215-678-6206
Mailing Address - Fax:
Practice Address - Street 1:1 UNION AVE UNIT 255
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3357
Practice Address - Country:US
Practice Address - Phone:215-678-6206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty