Healthcare Provider Details

I. General information

NPI: 1609925460
Provider Name (Legal Business Name): CHRISTOPHER CURTIS YOUNG LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4823 N ROYAL ATLANTA DR
TUCKER GA
30084-3806
US

IV. Provider business mailing address

4823 N ROYAL ATLANTA DR
TUCKER GA
30084-3806
US

V. Phone/Fax

Practice location:
  • Phone: 770-939-2121
  • Fax: 770-908-5784
Mailing address:
  • Phone: 770-939-2121
  • Fax: 770-908-5784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26926
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5332461-3501
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003889
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSW0000004932
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2114C
License Number StateAL
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC7426
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: