Provider Demographics
NPI:1992576714
Name:YAUROVA, INNA ALEX
Entity type:Individual
Prefix:
First Name:INNA
Middle Name:ALEX
Last Name:YAUROVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6415 CONIFER CIR
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-9539
Mailing Address - Country:US
Mailing Address - Phone:704-907-4811
Mailing Address - Fax:
Practice Address - Street 1:2407 PLANTATION CENTER DR UNIT 100
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5418
Practice Address - Country:US
Practice Address - Phone:704-907-4811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRBT-23-310851106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician