Provider Demographics
NPI:1215393814
Name:YOUNG, ADAM (LMSW)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1774 RIDGE VALLEY CT NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-1822
Mailing Address - Country:US
Mailing Address - Phone:678-699-5977
Mailing Address - Fax:
Practice Address - Street 1:4200 NORTHSIDE PKWY NW
Practice Address - Street 2:BUILDING ONE, SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-3007
Practice Address - Country:US
Practice Address - Phone:678-699-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0061171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical