Healthcare Provider Details

I. General information

NPI: 1245810779
Provider Name (Legal Business Name): CIGI YOUNG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 N MCKINLEY ST BLDG A
HENDERSON KY
42420-3687
US

IV. Provider business mailing address

3553 HENRYS WAY
HENDERSON KY
42420-9226
US

V. Phone/Fax

Practice location:
  • Phone: 364-643-1501
  • Fax: 270-826-2696
Mailing address:
  • Phone: 364-643-1501
  • Fax: 270-826-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number278592
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number259598
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: