Healthcare Provider Details

I. General information

NPI: 1245909217
Provider Name (Legal Business Name): ROBIN R YOUNG SUDCC II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2021
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 SIERRA COLLEGE DR
GRASS VALLEY CA
95945-5768
US

IV. Provider business mailing address

14447 PENN RD
GRASS VALLEY CA
95949-9547
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-9541
  • Fax:
Mailing address:
  • Phone: 916-289-2884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5988
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: