Provider Demographics
NPI:1730495482
Name:YOUTH EXCEL AND ADVANCEMENT, LLC
Entity type:Organization
Organization Name:YOUTH EXCEL AND ADVANCEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:ONEAL
Authorized Official - Last Name:HASKETT
Authorized Official - Suffix:SR
Authorized Official - Credentials:BA, SOCIOLOGY
Authorized Official - Phone:804-986-7036
Mailing Address - Street 1:4222 BONNIEBANK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23234-6633
Mailing Address - Country:US
Mailing Address - Phone:804-986-7036
Mailing Address - Fax:804-303-8657
Practice Address - Street 1:4222 BONNIEBANK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23234-6602
Practice Address - Country:US
Practice Address - Phone:804-986-7036
Practice Address - Fax:804-303-8657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management