Provider Demographics
NPI:1134294101
Name:YOUNG, TAMORA ELLEN (LPC MAC)
Entity Type:Individual
Prefix:
First Name:TAMORA
Middle Name:ELLEN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPC MAC
Other - Prefix:
Other - First Name:TAMORA
Other - Middle Name:ELLEN
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4396 LAWRENCEVILLE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052
Mailing Address - Country:US
Mailing Address - Phone:678-313-8784
Mailing Address - Fax:770-554-5584
Practice Address - Street 1:4396 LAWRENCEVILLE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052
Practice Address - Country:US
Practice Address - Phone:678-313-8784
Practice Address - Fax:770-554-5584
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC002129101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional