Healthcare Provider Details

I. General information

NPI: 1669644233
Provider Name (Legal Business Name): ROBIN ANNETTE YOUNG BA, TSWL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2157 GREENBRIER ST
CHARLESTON WV
25311-9623
US

IV. Provider business mailing address

2157 GREENBRIER ST
CHARLESTON WV
25311-9623
US

V. Phone/Fax

Practice location:
  • Phone: 304-344-5924
  • Fax: 304-344-3503
Mailing address:
  • Phone: 304-344-5924
  • Fax: 304-344-3503

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: