Healthcare Provider Details

I. General information

NPI: 1164368916
Provider Name (Legal Business Name): KEDAREA JANAE YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELIZABETH PL STE 111
DAYTON OH
45417-3445
US

IV. Provider business mailing address

4621 CHANNING LN
TROTWOOD OH
45416-1620
US

V. Phone/Fax

Practice location:
  • Phone: 937-520-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCAPRE.195778
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: