Provider Demographics
NPI:1578195103
Name:YOUNG, DARRIS (CADC-CAS)
Entity Type:Individual
Prefix:MR
First Name:DARRIS
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:CADC-CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 LEXINGTON AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-1979
Mailing Address - Country:US
Mailing Address - Phone:510-677-3408
Mailing Address - Fax:
Practice Address - Street 1:3315 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-3005
Practice Address - Country:US
Practice Address - Phone:510-300-3156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC055750518101YA0400X
CA179499101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)