Provider Demographics
NPI:1821219734
Name:YOUNG, TAMMY TERRELL (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:TERRELL
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 ROCKBRIDGE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3551
Mailing Address - Country:US
Mailing Address - Phone:404-916-4645
Mailing Address - Fax:
Practice Address - Street 1:2045 ROCKBRIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3551
Practice Address - Country:US
Practice Address - Phone:404-916-4645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005432101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional