MEDICARE: SHALIKA YOUNG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	13286	MO

General Provider Information

NPI Number	:	1245085141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHALIKA YOUNG

Provider Business Mailing Address
First Line	:	71 HOLLYWOOD AVE
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23661-3133
Country	:	US
Telephone Number	:	281-513-6833
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 HOLLYWOOD AVE
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23661-3133
Country	:	US
Telephone Number	:	281-513-6833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2024
Last Update Date	:	04/26/2024

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