Healthcare Provider Details

I. General information

NPI: 1487204434
Provider Name (Legal Business Name): ERICA JAMES YOUNG PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W EVANS ST
FLORENCE SC
29501-3469
US

IV. Provider business mailing address

1086 VIA SALVATORE
FLORENCE SC
29501-8966
US

V. Phone/Fax

Practice location:
  • Phone: 843-624-4125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1522
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: