=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144330259
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA B YOUNG LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 JORDAN LANE SUITE B
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35816-3030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-533-3717
-----------------------------------------------------
Fax | 256-536-8370
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1100 JORDAN LANE SUITE B
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35816-3030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-533-3717
-----------------------------------------------------
Fax | 256-536-8370
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0389C
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------