Provider Demographics
NPI:1477206134
Name:YOUNG, OLIVIA P (LPC)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:P
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-2562
Mailing Address - Country:US
Mailing Address - Phone:601-781-8677
Mailing Address - Fax:601-676-0550
Practice Address - Street 1:532 MAIN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-2562
Practice Address - Country:US
Practice Address - Phone:601-781-8677
Practice Address - Fax:601-676-0550
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2386101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional