Organization
YOUTH ACADEMY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN W FAIRLEY LCSW,MSW,ACSW (EXECUTIVE DIRECTOR)
(304) 363-3341
Entity
Organization
Contact information
Practice address
3 CROSSWINDS DR, FAIRMONT, WV 26554-9193
(304) 363-3341
(304) 363-3342
Mailing address
3 CROSSWINDS DR, FAIRMONT, WV 26554-9193
(304) 363-3341
(304) 363-3342
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810003254
—
WV
Enumeration date
04/23/2007
Last updated
08/22/2020
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