Provider Demographics
NPI:1619052958
Name:YOUNG, REBECCA-JO SALUNEK (LCSW, ADC)
Entity Type:Individual
Prefix:
First Name:REBECCA-JO
Middle Name:SALUNEK
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LCSW, ADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8794
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-0794
Mailing Address - Country:US
Mailing Address - Phone:757-705-8620
Mailing Address - Fax:
Practice Address - Street 1:225 W OLNEY RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1534
Practice Address - Country:US
Practice Address - Phone:757-823-1600
Practice Address - Fax:757-823-1601
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040035381041C0700X
VA06000911A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAO83896OtherOPTIMA
VA004945395Medicaid
VA285589OtherANTHEM
VA004945395OtherVA PREMIER
VA011950C34Medicare PIN