Healthcare Provider Details

I. General information

NPI: 1740199611
Provider Name (Legal Business Name): CHINA TATYANNA YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHINA TATYANNA JOHNSON YOUNG

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 S HOUSTON LAKE RD BLDG J
WARNER ROBINS GA
31088-9027
US

IV. Provider business mailing address

104 SIG CT
KATHLEEN GA
31047-1109
US

V. Phone/Fax

Practice location:
  • Phone: 478-777-5284
  • Fax: 470-290-6429
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC011397
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: