Provider Demographics
NPI:1093451056
Name:YOUNG, JEANNIE MARIE (LLPC)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:MARIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LLPC
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 3214
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48037-3214
Mailing Address - Country:US
Mailing Address - Phone:248-910-0607
Mailing Address - Fax:
Practice Address - Street 1:27780 NOVI RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3401
Practice Address - Country:US
Practice Address - Phone:248-916-2855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451017837101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor