Organization
FAVOR YOUTH SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SEAN TRAMALLE GRAY QMHP (EXECUTIVE DIRECTOR)
(704) 866-9177
Entity
Organization
Contact information
Practice address
1568 UNION RD STE A, GASTONIA, NC 28054-2211
(704) 866-9177
(704) 866-9176
Mailing address
1568 UNION RD STE A, GASTONIA, NC 28054-2211
(704) 866-9177
(704) 866-9176
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
251B00000X
NC
251C00000X
Developmentally Disabled Services Day Training Agency
251C00000X
NC
251S00000X
Community/Behavioral Health Agency
Primary
251S00000X
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3418155
CAP NUMBER
NC
05
—
8300200B
—
NC
Enumeration date
12/14/2006
Last updated
11/16/2009
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