Healthcare Provider Details

I. General information

NPI: 1124959663
Provider Name (Legal Business Name): EMMA YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 DYE DR STE A
BECKLEY WV
25801-2636
US

IV. Provider business mailing address

605 KNOLLS DR
DANIELS WV
25832-9474
US

V. Phone/Fax

Practice location:
  • Phone: 304-860-5659
  • Fax:
Mailing address:
  • Phone: 304-860-5659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW042617849
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: