Provider Demographics
NPI:1326231382
Name:YOUNG, GREGORY ANTONIO SR (LMSW)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ANTONIO
Last Name:YOUNG
Suffix:SR
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 1:3308 LEHIGH DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-9101
Mailing Address - Country:US
Mailing Address - Phone:501-912-2295
Mailing Address - Fax:
Practice Address - Street 1:3308 LEHIGH DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-9101
Practice Address - Country:US
Practice Address - Phone:501-912-2295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical