Provider Demographics
NPI:1790182970
Name:YOUNG, DENISE ANGELINA (CAARR CERTIFICATE)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:ANGELINA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CAARR CERTIFICATE
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:ANGELINA
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAARR CERTIFICATION
Mailing Address - Street 1:4974 EL CAJON BLVD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-2476
Mailing Address - Country:US
Mailing Address - Phone:619-286-4600
Mailing Address - Fax:619-286-0060
Practice Address - Street 1:4974 EL CAJON BLVD.
Practice Address - Street 2:SUITE A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-2476
Practice Address - Country:US
Practice Address - Phone:619-286-4600
Practice Address - Fax:619-286-0060
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-03
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty