Healthcare Provider Details

I. General information

NPI: 1659750180
Provider Name (Legal Business Name): AMY DEYOUNG MA, LGPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 HUNT PL NE
WASHINGTON DC
20019-3565
US

IV. Provider business mailing address

425 WARNER ST NW
WASHINGTON DC
20001-2409
US

V. Phone/Fax

Practice location:
  • Phone: 202-388-4300
  • Fax: 202-388-4333
Mailing address:
  • Phone: 202-986-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGPC0004
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP6173
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number336557
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: