Provider Demographics
NPI:1083211015
Name:YOUNG, CALANDRA BURKE (LMSW)
Entity Type:Individual
Prefix:
First Name:CALANDRA
Middle Name:BURKE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SOCIAL CIRCLE
Mailing Address - State:GA
Mailing Address - Zip Code:30025-3074
Mailing Address - Country:US
Mailing Address - Phone:478-251-3409
Mailing Address - Fax:
Practice Address - Street 1:274 CEDAR ST
Practice Address - Street 2:
Practice Address - City:SOCIAL CIRCLE
Practice Address - State:GA
Practice Address - Zip Code:30025-3074
Practice Address - Country:US
Practice Address - Phone:478-251-3409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW008824104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAMSW008824OtherGEORGIA BOARD OF PROFESSIONAL COUNSELORS, SOCIAL WORKERS, AND MARRIAGE &FAMILY
GA14975808OtherCAQH