Provider Demographics
NPI:1629779483
Name:YOUNG, SOPHIE (MA, LCMHCA)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MA, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 FAIRMONT ST APT C
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1985
Mailing Address - Country:US
Mailing Address - Phone:336-541-3717
Mailing Address - Fax:
Practice Address - Street 1:5587 GARDEN VILLAGE WAY STE D
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-8590
Practice Address - Country:US
Practice Address - Phone:336-272-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18441101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty