Provider Demographics
NPI:1568802551
Name:YOUNG, ANDREA LEE (MA, LCDC)
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:LEE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MA, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SOUTH GAINES, SUITE 105
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119
Mailing Address - Country:US
Mailing Address - Phone:972-921-2244
Mailing Address - Fax:972-875-3808
Practice Address - Street 1:107 S GAINES ST STE 105
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-4612
Practice Address - Country:US
Practice Address - Phone:972-921-2244
Practice Address - Fax:972-875-3808
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11109101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)