Healthcare Provider Details

I. General information

NPI: 1619136645
Provider Name (Legal Business Name): NICOLE L YOUNG LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6061 COLONIAL PKWY UNIT 7103
GULF SHORES AL
36542-5509
US

IV. Provider business mailing address

6061 COLONIAL PKWY UNIT 7103
GULF SHORES AL
36542-5509
US

V. Phone/Fax

Practice location:
  • Phone: 617-212-7645
  • Fax:
Mailing address:
  • Phone: 270-216-1662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3456
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5323-C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: