Provider Demographics
NPI:1487197471
Name:ROB YOUNG, PSYD, BCB
Entity Type:Organization
Organization Name:ROB YOUNG, PSYD, BCB
Other - Org Name:CHARLOTTESVILLE CENTER FOR COGNITIVE BEHAVIORAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:434-566-0113
Mailing Address - Street 1:3 BOARS HEAD LN
Mailing Address - Street 2:STE C-6
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4610
Mailing Address - Country:US
Mailing Address - Phone:434-566-0113
Mailing Address - Fax:888-772-2504
Practice Address - Street 1:3 BOARS HEAD LN
Practice Address - Street 2:STE C-6
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4610
Practice Address - Country:US
Practice Address - Phone:434-566-0113
Practice Address - Fax:888-772-2504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004974101YP2500X
VA0810004393103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty