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General NPI Number Information
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NPI Number | 1255057105
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Entity Type | Individual
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Provider Name | CAROLINE VICTORIA YOUNG LP
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Gender | Female
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Dates
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Enumeration Date | 10/12/2022
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Last Update Date | 10/12/2022
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Provider Practice Location Address
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Address Line | 15720 BRIXHAM HILL AVE STE 150
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City | CHARLOTTE
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State | NC
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Zip | 28277-4785
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Country | US
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Telephone | 704-970-4791
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 35
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City | FAIRFAX
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State | SC
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Zip | 29827-0035
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Country | US
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Telephone | 803-686-1219
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6229
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License Number State | NC
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