Provider Demographics
NPI:1467042705
Name:YOUNG, KRISTIN KARAE'
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:KARAE'
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 REMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5315
Mailing Address - Country:US
Mailing Address - Phone:404-610-6551
Mailing Address - Fax:
Practice Address - Street 1:196 W GA HIGHWAY 49 APT F2
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-5142
Practice Address - Country:US
Practice Address - Phone:404-610-6551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional