Healthcare Provider Details

I. General information

NPI: 1972785756
Provider Name (Legal Business Name): ROCHELLE YOUNG M.A., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316- A GRANITE AVE. NW
ALBUQUERQUE NM
87104
US

IV. Provider business mailing address

1316- A GRANITE AVE. NW
ALBUQUERQUE NM
87104
US

V. Phone/Fax

Practice location:
  • Phone: 505-506-3886
  • Fax:
Mailing address:
  • Phone: 505-506-3886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068-75737
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0143771
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0143781
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: