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General NPI Number Information
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NPI Number | 1841959434
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Entity Type | Individual
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Provider Name | CORINNA EVON YOUNG
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Gender | Female
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Dates
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Enumeration Date | 12/11/2021
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 8801 FAST PARK DR. SUITE 301 #1044
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City | RALEIGH
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State | NC
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Zip | 27617
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Country | US
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Telephone | 919-576-5569
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Fax |
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Provider Business Mailing Address
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Address Line | 8801 FAST PARK DR STE 301 #1044
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City | RALEIGH
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State | NC
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Zip | 27617-4853
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Country | US
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Telephone | 919-576-5569
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Fax | 919-573-0768
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | A17153
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License Number State | NC
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