Organization
ST JOHNS YOUTH ACADEMY
Active
Other names
Youth Services International, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BARIKA GRAYSON L.M.H.C. (CLINICAL DIRECTOR)
(904) 829-8850
Entity
Organization
Contact information
Practice address
4500 AVENUE D, ST AUGUSTINE, FL 32095-5245
(904) 829-8850
(904) 829-8851
Mailing address
4500 AVENUE D, ST AUGUSTINE, FL 32095-5245
(904) 829-8850
(904) 829-8851
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
0755AD5690-09
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0755AD5690-09
SUBSTANCE ABUSE LICENSE
FL
Enumeration date
05/24/2010
Last updated
05/24/2010
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