Provider Demographics
NPI:1780187401
Name:YOUNG, TRAVIS D II
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:D
Last Name:YOUNG
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N CHARLES ST STE 202
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5907
Mailing Address - Country:US
Mailing Address - Phone:443-279-7396
Mailing Address - Fax:410-878-1962
Practice Address - Street 1:1800 N CHARLES ST STE 202
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5907
Practice Address - Country:US
Practice Address - Phone:443-279-7396
Practice Address - Fax:410-878-1962
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710103129101YP2500X
VA2058101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)