MEDICARE: DR. LETITIA VONISE YOUNG LSW, LICDC

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	1041C0700X	Clinical Social Worker	S.1904578	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	LICDC.162015	OH

General Provider Information

NPI Number	:	1447778857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LETITIA VONISE YOUNG LSW, LICDC

Provider Business Mailing Address
First Line	:	6350 HATHAWAY RD APT 2
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-4961
Country	:	US
Telephone Number	:	216-253-5825
Fax Number	:

Provider Business Practice Location Address
First Line	:	6350 HATHAWAY RD APT 2
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-4961
Country	:	US
Telephone Number	:	216-253-5825
Fax Number	:

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

Provider Enumeration Date	:	09/06/2017
Last Update Date	:	05/09/2025

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