Provider Demographics
NPI:1184849960
Name:YOUNG, JOHN LAFAYETTE (DMIN LCPC LCADC PROF)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LAFAYETTE
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DMIN LCPC LCADC PROF
Other - Prefix:
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Mailing Address - Street 1:4 SIX POINT COURT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2073
Mailing Address - Country:US
Mailing Address - Phone:410-922-0830
Mailing Address - Fax:410-922-0232
Practice Address - Street 1:3527 ROLLING RD
Practice Address - Street 2:SUITE 23
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2073
Practice Address - Country:US
Practice Address - Phone:410-922-0830
Practice Address - Fax:410-922-0232
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA350101YA0400X
MDLC0538101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health