Provider Demographics
NPI:1083169098
Name:YOUNG, ASHLEY (LPCI)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPCI
Other - Prefix:MRS
Other - First Name:ASHLEY
Other - Middle Name:M
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:408 UPPER FOREST LN
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-7199
Mailing Address - Country:US
Mailing Address - Phone:803-537-1854
Mailing Address - Fax:
Practice Address - Street 1:408 UPPER FOREST LN
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-7199
Practice Address - Country:US
Practice Address - Phone:803-537-1854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5993101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional