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Certified Provider Details:
| PROVIDER NUMBER: | 490108 |
| AGENCY NAME: | National Youth Advocate Program |
| CONTACT NAME: | Barbara Goldman |
| ADDRESS: | 1801 Watermark Drive, Suite 200 |
| CITY: | Columbus |
| STATE: | OH |
| ZIP: | 43215 |
| PHONE: | (614) 487-3880 |
| WEB SITE: | www.nyap.org |
| EMAIL ADDRESS: | bgoldman@nyap.org |
| BSW/MSW NAME: | Renee Ellenberger, LGSW |
| DUE TO RECERTIFY DATE: | 7/1/2011 |
| COMMENTS: |