Provider Demographics
NPI:1578789327
Name:YOUNG, RICHARD DWAYNE II (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:DWAYNE
Last Name:YOUNG
Suffix:II
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 HILLCREST TRL
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-8447
Mailing Address - Country:US
Mailing Address - Phone:225-202-0236
Mailing Address - Fax:
Practice Address - Street 1:211 E SOUTHLAKE BLVD STE 111
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6274
Practice Address - Country:US
Practice Address - Phone:225-202-0236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX575151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical