The Youth Academy, Inc.

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

SR-0001723001-GH Issued in SC

Legal business name

THE YOUTH ACADEMY, INC.

Doing business as

The Youth Academy Group Home

Practice address

237 Lela Harrison Rd
Kingstree, SC 29556-6771

Phone

(843) 382-5927

Fax

(843) 382-5826

NPI assigned

May 7, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Daphne Wilson Boston, LCS

Title

Executive Director / LCS

Phone

(843) 382-5927

Specialties & licenses 2

Addresses

Other names 1

• The Youth Academy Group Home Doing business as

Tax ID family

The Youth Academy Group Home2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• The Youth Academy Inc

  dba Youth Academy Group Home

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Kingstree, SC
  • NPI 1497825723
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073562211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "237 LELA HARRISON RD",
            "address_2": "PO BOX 174",
            "city": "KINGSTREE",
            "state": "SC",
            "postal_code": "295566771",
            "telephone_number": "843-382-5927",
            "fax_number": "843-382-5826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "237 LELA HARRISON RD",
            "city": "KINGSTREE",
            "state": "SC",
            "postal_code": "295566771",
            "telephone_number": "843-382-5927",
            "fax_number": "843-382-5826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE YOUTH ACADEMY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOSTON",
        "authorized_official_first_name": "DAPHNE",
        "authorized_official_middle_name": "WILSON",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR / LCS",
        "authorized_official_telephone_number": "843-382-5927",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCS"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "SC",
            "license": "SR-0001723001-GH",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "SC",
            "license": "SR-0008158001-CCI",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Youth Academy Group Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mary Thomas
• Olisha Chaquetta Thompson
• Kaycee Tisdale, PHARMD

• Professional Counselor in Kingstree, SC
• Providers in Kingstree, SC by specialty
• Professional Counselor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.