Provider Demographics
NPI:1447778857
Name:YOUNG, LETITIA VONISE (LSW, LICDC)
Entity Type:Individual
Prefix:
First Name:LETITIA
Middle Name:VONISE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LSW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6350 HATHAWAY RD APT 2
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-4961
Mailing Address - Country:US
Mailing Address - Phone:216-253-5825
Mailing Address - Fax:
Practice Address - Street 1:6350 HATHAWAY RD APT 2
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-4961
Practice Address - Country:US
Practice Address - Phone:216-253-5825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1904578104100000X
OHLICDC.162015101YA0400X
OH140154101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker