Provider Demographics
NPI:1710231055
Name:YOUNG, SHKETHIA ANDREA (MSW,LCSWA)
Entity Type:Individual
Prefix:MS
First Name:SHKETHIA
Middle Name:ANDREA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MSW,LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8619 OAK DR NE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1650
Mailing Address - Country:US
Mailing Address - Phone:704-208-0742
Mailing Address - Fax:
Practice Address - Street 1:8619 OAK DR NE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-1650
Practice Address - Country:US
Practice Address - Phone:704-208-0742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0063661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical