Provider Demographics
NPI:1437218849
Name:CHA, MI YOUNG (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MI
Middle Name:YOUNG
Last Name:CHA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9249 HIGHWAY 29 S
Mailing Address - Street 2:SUITE A
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-6352
Mailing Address - Country:US
Mailing Address - Phone:706-227-4534
Mailing Address - Fax:706-227-4538
Practice Address - Street 1:9249 HIGHWAY 29 S
Practice Address - Street 2:SUITE A
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-6352
Practice Address - Country:US
Practice Address - Phone:706-227-4534
Practice Address - Fax:706-227-4538
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0034061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical