Healthcare Provider Details

I. General information

NPI: 1184553729
Provider Name (Legal Business Name): SHANTEE LATRICE YOUNGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7960 DONEGAN DR STE 200
MANASSAS VA
20109-8236
US

IV. Provider business mailing address

7960 DONEGAN DR STE 200
MANASSAS VA
20109-8236
US

V. Phone/Fax

Practice location:
  • Phone: 571-208-0592
  • Fax:
Mailing address:
  • Phone: 434-429-2253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704017999
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: