Youthful Image Inc

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

041746 Issued in NC

Legal business name

YOUTHFUL IMAGE INC

Practice address

912 Ashe St
Greensboro, NC 27406-1204

Phone

(336) 691-5748

NPI assigned

Jan 19, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Brian Lamont SeagravesNPI 1194857474

Title

Ceo

Phone

(336) 209-5122

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brian Lamont Seagraves

  • Lodging Provider
  • Greensboro, NC
  • NPI 1194857474
  NPD (past) Authorized official

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457404709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "853 BLAZINGWOOD DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274068228",
            "telephone_number": "336-209-5122",
            "fax_number": "336-638-9400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 ASHE ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274061204",
            "telephone_number": "336-691-5748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUTHFUL IMAGE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SEAGRAVES",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "LAMONT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "336-209-5122",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "041746",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603915",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Youth Profile, Inc.
• Youth Stars
• Youth Villages
• Amanda Pace Youth, CRNA
• Lynn N. Yow, NP
• Yram Home Care LLC
• Yram Home Care LLC
• Hoi Tik Hyde Yuen
• Jaclyn Yuro

• Mental Health Counselor in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Mental Health Counselor in North 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.