Provider Demographics
NPI:1629534136
Name:YOUNGSTROM, KRISTEN LEE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LEE
Last Name:YOUNGSTROM
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-3780
Mailing Address - Country:US
Mailing Address - Phone:410-887-0857
Mailing Address - Fax:
Practice Address - Street 1:1410 PLEASANT VALLEY DR
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-2539
Practice Address - Country:US
Practice Address - Phone:410-887-0857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD176801041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool