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NPI Code Detail

MEDICARE: MR. ROBERT C. YOUNG LICDC

MEDICARE:  MR. ROBERT C. YOUNG  LICDC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor981159OH

General Provider Information

NPI Number : 1871706424
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBERT C. YOUNG LICDC
Provider Business Mailing Address
First Line : 155 N WATER ST
Second Line :
City : KENT
State : OH
Zip : 44240-2418
Country : US
Telephone Number : 330-678-3006
Fax Number : 330-677-7047
Provider Business Practice Location Address
First Line : 155 N WATER ST
Second Line :
City : KENT
State : OH
Zip : 44240-2418
Country : US
Telephone Number : 330-678-3006
Fax Number : 330-677-7047
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2007
Last Update Date : 07/17/2007

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Directions to “ MR. ROBERT C. YOUNG LICDC” Practice Location

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