Provider Demographics
NPI:1679850481
Name:VERLEE V YOUNG LCSW ACSW PIP LLC
Entity Type:Organization
Organization Name:VERLEE V YOUNG LCSW ACSW PIP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:EDEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:251-269-5936
Mailing Address - Street 1:307 S MCKENZIE ST STE 111
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-1947
Mailing Address - Country:US
Mailing Address - Phone:251-269-5936
Mailing Address - Fax:251-974-3113
Practice Address - Street 1:307 S MCKENZIE ST STE 111
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-1947
Practice Address - Country:US
Practice Address - Phone:251-269-5936
Practice Address - Fax:251-974-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1621C251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health