Provider Demographics
NPI:1558668459
Name:YOUNG, ERICA CHRISTINE
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:CHRISTINE
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 1:515 E GAULT WAY
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-2482
Mailing Address - Country:US
Mailing Address - Phone:775-432-1035
Mailing Address - Fax:775-384-6685
Practice Address - Street 1:515 E GAULT WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-2482
Practice Address - Country:US
Practice Address - Phone:775-432-1035
Practice Address - Fax:775-384-6685
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100511515Medicaid