Provider Demographics
NPI:1003186818
Name:YOUNG, EDGAR T (CADC II, CAS II)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:T
Last Name:YOUNG
Suffix:
Gender:M
Credentials:CADC II, CAS II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4219 TIBURON DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-3261
Mailing Address - Country:US
Mailing Address - Phone:510-794-7262
Mailing Address - Fax:
Practice Address - Street 1:4219 TIBURON DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-3261
Practice Address - Country:US
Practice Address - Phone:510-794-7262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)