Healthcare Provider Details

I. General information

NPI: 1356268460
Provider Name (Legal Business Name): YOUNG CHRISTIAN PROFESSIONALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CLEVELAND AVE SW
CANTON OH
44702-1904
US

IV. Provider business mailing address

120 CLEVELAND AVE SW
CANTON OH
44702-1904
US

V. Phone/Fax

Practice location:
  • Phone: 234-214-3534
  • Fax: 800-212-5879
Mailing address:
  • Phone: 234-214-3534
  • Fax: 800-212-5879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: NICOLE DICKSON
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 330-605-5060