Provider Demographics
NPI:1053862458
Name:YOUNG, COLLEEN A (MA/EDS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:A
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MA/EDS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 CENTURY LN
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-6007
Mailing Address - Country:US
Mailing Address - Phone:908-385-8366
Mailing Address - Fax:908-754-4882
Practice Address - Street 1:776 MOUNTAIN BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-6269
Practice Address - Country:US
Practice Address - Phone:908-385-8366
Practice Address - Fax:908-754-4882
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00555600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional