Provider Demographics
NPI:1083902019
Name:YOUNG, MARIANNE
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 121
Mailing Address - Street 2:
Mailing Address - City:TOK
Mailing Address - State:AK
Mailing Address - Zip Code:99780-0121
Mailing Address - Country:US
Mailing Address - Phone:907-883-5185
Mailing Address - Fax:907-459-3925
Practice Address - Street 1:204 EAST CHENA WAY
Practice Address - Street 2:
Practice Address - City:TOK
Practice Address - State:AK
Practice Address - Zip Code:99780
Practice Address - Country:US
Practice Address - Phone:907-883-5185
Practice Address - Fax:907-459-3925
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)