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Organization
YOUTHFUL IMAGE INC
Active
Organization
YOUTHFUL IMAGE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN LAMONT SEAGRAVES (CEO)
(336) 209-5122
Entity
Organization
Contact information
Practice address
912 ASHE ST, GREENSBORO, NC 27406-1204
(336) 691-5748
Mailing address
853 BLAZINGWOOD DR, GREENSBORO, NC 27406-8228
(336) 209-5122
(336) 638-9400
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
041746
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603915
—
NC
Enumeration date
01/19/2007
Last updated
08/22/2020
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