Provider Demographics
NPI:1427593383
Name:YOUNG, BECKY (LCAS)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235B E SALISBURY ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5543
Mailing Address - Country:US
Mailing Address - Phone:336-625-5509
Mailing Address - Fax:335-736-8549
Practice Address - Street 1:235B E SALISBURY ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5543
Practice Address - Country:US
Practice Address - Phone:336-625-5509
Practice Address - Fax:335-736-8549
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23008174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist