Provider Demographics
NPI:1225237183
Name:SUSAN L. YOUNG, INC.
Entity Type:Organization
Organization Name:SUSAN L. YOUNG, INC.
Other - Org Name:AMERICAS CENTER FOR CHANGE, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT / SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LUKE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, LCAS
Authorized Official - Phone:704-540-3055
Mailing Address - Street 1:3111 SPRINGBANK LN
Mailing Address - Street 2:SUITE I
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3372
Mailing Address - Country:US
Mailing Address - Phone:704-540-3055
Mailing Address - Fax:704-540-2762
Practice Address - Street 1:3111 SPRINGBANK LN
Practice Address - Street 2:SUITE I
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3372
Practice Address - Country:US
Practice Address - Phone:704-540-3055
Practice Address - Fax:704-540-2762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2008-12-01
Deactivation Date:2007-08-09
Deactivation Code:
Reactivation Date:2008-11-24
Provider Licenses
StateLicense IDTaxonomies
NC1106101YA0400X
NCC0033351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty