Provider Demographics
NPI:1326521105
Name:YOUNG, MONIQUE NICOLE (SUD COUNSELOR)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:NICOLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:SUD COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W MANCHESTER BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1196
Mailing Address - Country:US
Mailing Address - Phone:131-067-2382
Mailing Address - Fax:310-672-3822
Practice Address - Street 1:405 W MANCHESTER BLVD STE A
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1196
Practice Address - Country:US
Practice Address - Phone:131-067-2382
Practice Address - Fax:310-672-3822
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD1264634OtherSUBSTANCE ABUSE TREATMENT PROGRAM