Provider Demographics
NPI:1407170269
Name:YOUNG, CLIFTON III (MA, LPC, CDC II)
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:
Last Name:YOUNG
Suffix:III
Gender:M
Credentials:MA, LPC, CDC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E PARKS HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8162
Mailing Address - Country:US
Mailing Address - Phone:907-795-3860
Mailing Address - Fax:
Practice Address - Street 1:701 E PARKS HWY STE 203
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8162
Practice Address - Country:US
Practice Address - Phone:907-795-3860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)