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General NPI Number Information
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NPI Number | 1821367392
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Entity Type | Individual
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Provider Name | LANA ROSE YOUNG CAADE II/CATC II
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Gender | Female
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Dates
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Enumeration Date | 12/29/2011
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 201 D ST STE G
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City | MARYSVILLE
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State | CA
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Zip | 95901-5957
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Country | US
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Telephone | 707-467-2010
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Fax | 707-462-6994
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Provider Business Mailing Address
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Address Line | 201 D ST STE G
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City | MARYSVILLE
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State | CA
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Zip | 95901-5957
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Country | US
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Telephone | 650-817-9070
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Fax | 650-246-3838
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 2326
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License Number State | CA
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