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General NPI Number Information
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NPI Number | 1780976092
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Entity Type | Organization
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Legal Business Name | YOUNG & BROVET, INC.
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 2435 LYNN RD STE 200
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City | RALEIGH
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State | NC
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Zip | 27612-6756
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Country | US
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Telephone | 919-741-1972
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Fax | 919-845-4714
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Provider Business Mailing Address
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Address Line | 2435 LYNN RD STE 200
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City | RALEIGH
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State | NC
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Zip | 27612-6756
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Country | US
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Telephone | 919-741-1972
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Fax | 919-845-4714
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Authorized Official
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Title or Position | MANAGING PARTNER/PSYCHOLOGIST
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Name | DR. JASON WILEY YOUNG
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Credential | PSYD.
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Telephone | 919-741-1972
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 911
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3275
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License Number State | NC
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