Provider Demographics
NPI:1659750180
Name:DEYOUNG, AMY (MA, LGPC, NCC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:DEYOUNG
Suffix:
Gender:F
Credentials:MA, LGPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 WARNER ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-2409
Mailing Address - Country:US
Mailing Address - Phone:202-986-2233
Mailing Address - Fax:
Practice Address - Street 1:4130 HUNT PL NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-3565
Practice Address - Country:US
Practice Address - Phone:202-388-4300
Practice Address - Fax:202-388-4333
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC0004101YM0800X
MDLGP6173101YM0800X
DC336557101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health