Provider Demographics
NPI:1578705026
Name:YOUNG, QIANA RENEE' (LPC)
Entity Type:Individual
Prefix:MRS
First Name:QIANA
Middle Name:RENEE'
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 1:864 MONTCLAIR ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3889
Mailing Address - Country:US
Mailing Address - Phone:501-442-0911
Mailing Address - Fax:
Practice Address - Street 1:17680 I 30 STE 1
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-2921
Practice Address - Country:US
Practice Address - Phone:501-575-2344
Practice Address - Fax:501-242-7009
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1705292101YM0800X
ARA1405077101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty