Healthcare Provider Details

I. General information

NPI: 1457230534
Provider Name (Legal Business Name): JACOLBY YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8141 TELEGRAPH RD
SEVERN MD
21144-3256
US

IV. Provider business mailing address

8187 CLARK RD
FORT MEADE MD
20755-1120
US

V. Phone/Fax

Practice location:
  • Phone: 410-672-2862
  • Fax:
Mailing address:
  • Phone: 619-387-6932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: