Provider Demographics
NPI:1386670909
Name:YOUNG, JULIANNE TUCKER (MSW, LCSW, LISW)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:TUCKER
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MSW, LCSW, LISW
Other - Prefix:
Other - First Name:JULIANNE
Other - Middle Name:
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW, LISW
Mailing Address - Street 1:16147 LANCASTER HWY
Mailing Address - Street 2:110
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2050
Mailing Address - Country:US
Mailing Address - Phone:980-253-0988
Mailing Address - Fax:704-208-4462
Practice Address - Street 1:16147 LANCASTER HWY
Practice Address - Street 2:110
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2050
Practice Address - Country:US
Practice Address - Phone:980-253-0988
Practice Address - Fax:704-540-4833
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0034621041C0700X
FLSW-00044901041C0700X
SC111071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12788OtherBLUECROSS BLUESHIELD