Healthcare Provider Details

I. General information

NPI: 1780976092
Provider Name (Legal Business Name): YOUNG & BROVET, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 LYNN RD STE 200
RALEIGH NC
27612-6756
US

IV. Provider business mailing address

2435 LYNN RD STE 200
RALEIGH NC
27612-6756
US

V. Phone/Fax

Practice location:
  • Phone: 919-741-1972
  • Fax: 919-845-4714
Mailing address:
  • Phone: 919-741-1972
  • Fax: 919-845-4714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3275
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number911
License Number StateNC

VIII. Authorized Official

Name: DR. JASON WILEY YOUNG
Title or Position: MANAGING PARTNER/PSYCHOLOGIST
Credential: PSYD.
Phone: 919-741-1972