Provider Demographics
NPI:1366640617
Name:YOUNG, RACHEL MARIE (LISW, LSCSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LISW, LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8135 MOUNT VERNON RD
Mailing Address - Street 2:
Mailing Address - City:ST LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43071-9670
Mailing Address - Country:US
Mailing Address - Phone:740-345-5437
Mailing Address - Fax:888-206-4492
Practice Address - Street 1:151 MARION AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-2223
Practice Address - Country:US
Practice Address - Phone:419-774-9969
Practice Address - Fax:419-756-5642
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-09
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS40241041C0700X
OHI.11000651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical