| Youthful Image Inc | |
|
912 Ashe St Greensboro NC 27406-1204 | |
| (336) 691-5748 | |
| Not Available |
| Full Name | Youthful Image Inc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 912 Ashe St, Greensboro, North Carolina |
| Authorized Official Name and Position | Brian Lamont Seagraves (CEO) |
| Authorized Official Contact | 3362095122 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Youthful Image Inc 853 Blazingwood Dr Greensboro NC 27406-8228 Ph: (336) 209-5122 | Youthful Image Inc 912 Ashe St Greensboro NC 27406-1204 Ph: (336) 691-5748 |
| NPI Number | 1457404709 |
|---|---|
| Provider Enumeration Date | 01/19/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457404709 | NPI | - | NPPES |
| 6603915 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 041746 (North Carolina) | Primary |
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