Provider Demographics
NPI:1235783259
Name:YOUNG, KRISTIN LEI (CSC-AD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEI
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CSC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17645 HARBAUGH VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SABILLASVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21780-9616
Mailing Address - Country:US
Mailing Address - Phone:757-561-8184
Mailing Address - Fax:
Practice Address - Street 1:17645 HARBAUGH VALLEY RD
Practice Address - Street 2:
Practice Address - City:SABILLASVILLE
Practice Address - State:MD
Practice Address - Zip Code:21780-9616
Practice Address - Country:US
Practice Address - Phone:301-241-3629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC2015101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)