Healthcare Provider Details

I. General information

NPI: 1215261185
Provider Name (Legal Business Name): CHASTITY NICOLE YOUNG LPC LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: C. NICOLE YOUNG LPC LMFT

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 S JEFFERSON AVE
COVINGTON LA
70433-3169
US

IV. Provider business mailing address

100 FORDOCHE PL
MANDEVILLE LA
70471-1708
US

V. Phone/Fax

Practice location:
  • Phone: 985-778-4978
  • Fax:
Mailing address:
  • Phone: 985-778-4978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3868
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1131
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: