Provider Demographics
NPI:1144219650
Name:YOUNG, JAMES HENRY JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HENRY
Last Name:YOUNG
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 602120
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2120
Mailing Address - Country:US
Mailing Address - Phone:704-863-9830
Mailing Address - Fax:704-863-9831
Practice Address - Street 1:5435 PROSPERITY CHURCH RD
Practice Address - Street 2:SUITE 2200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-2331
Practice Address - Country:US
Practice Address - Phone:704-863-9830
Practice Address - Fax:704-863-9831
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC996103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000285Medicaid
NC2816898AMedicare PIN
NC6000285Medicaid