Provider Demographics
NPI:1710075577
Name:YOUNGBLOOD, JOSEPH JONATHAN (COUNSELOR)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:JONATHAN
Last Name:YOUNGBLOOD
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:
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Mailing Address - Street 1:1903 BRAGG BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4563
Mailing Address - Country:US
Mailing Address - Phone:910-223-3737
Mailing Address - Fax:910-223-3737
Practice Address - Street 1:1903 BRAGG BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4563
Practice Address - Country:US
Practice Address - Phone:910-223-3737
Practice Address - Fax:910-223-3737
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2902101Y00000X, 101YM0800X
NC431101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)