Healthcare Provider Details

I. General information

NPI: 1881688240
Provider Name (Legal Business Name): RENEE E YOUNG MS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E 3RD ST
WASHINGTON NC
27889-4923
US

IV. Provider business mailing address

105 E 3RD ST
WASHINGTON NC
27889-4923
US

V. Phone/Fax

Practice location:
  • Phone: 252-975-2027
  • Fax: 252-975-3483
Mailing address:
  • Phone: 252-975-2027
  • Fax: 252-975-3483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number124
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: