Healthcare Provider Details

I. General information

NPI: 1306665617
Provider Name (Legal Business Name): ERIC DALE YOUNG M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERIMETER PARK S STE 100N
BIRMINGHAM AL
35243-3248
US

IV. Provider business mailing address

1 PERIMETER PARK S STE 100N
BIRMINGHAM AL
35243-3248
US

V. Phone/Fax

Practice location:
  • Phone: 205-936-2356
  • Fax: 205-273-5033
Mailing address:
  • Phone: 205-936-2356
  • Fax: 205-273-5033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC06118
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: