Provider Demographics
NPI:1003568684
Name:YOUNG, CALVIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 OXFORD PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW KGN
Mailing Address - State:KSAMC
Mailing Address - Zip Code:00000
Mailing Address - Country:JM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7 OXFORD PARK AVENUE
Practice Address - Street 2:
Practice Address - City:NEW KGN
Practice Address - State:KSAMC
Practice Address - Zip Code:000000
Practice Address - Country:JM
Practice Address - Phone:876-505-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005281101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health