Organization
THE YOUTH ACADEMY, INC.
Active
Other names
The Youth Academy Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DAPHNE WILSON BOSTON LCS (EXECUTIVE DIRECTOR / LCS)
(843) 382-5927
Entity
Organization
Contact information
Practice address
237 LELA HARRISON RD, KINGSTREE, SC 29556-6771
(843) 382-5927
(843) 382-5826
Mailing address
237 LELA HARRISON RD, PO BOX 174, KINGSTREE, SC 29556-6771
(843) 382-5927
(843) 382-5826
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
SR-0001723001-GH
SC
101YP2500X
Professional Counselor
SR-0008158001-CCI
SC
Other
Enumeration date
05/07/2006
Last updated
08/22/2020
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