Healthcare Provider Details

I. General information

NPI: 1790339653
Provider Name (Legal Business Name): RICHARD ALLEN YOUNG LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PEGASUS CT STE 500
WINCHESTER VA
22602-4596
US

IV. Provider business mailing address

22 KENDIG LN
MARTINSBURG WV
25404-7773
US

V. Phone/Fax

Practice location:
  • Phone: 540-313-4196
  • Fax: 540-686-7906
Mailing address:
  • Phone: 240-469-1383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: