Provider Demographics
NPI:1881216158
Name:YOUNG, ANTHONY DEJOHN (MA, LCDC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DEJOHN
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MA, LCDC
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:DEJOHN
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LCDC
Mailing Address - Street 1:2219 GREENHOUSE RD APT 2306
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7318
Mailing Address - Country:US
Mailing Address - Phone:832-752-4772
Mailing Address - Fax:
Practice Address - Street 1:2219 GREENHOUSE RD APT 2306
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7318
Practice Address - Country:US
Practice Address - Phone:832-752-4772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-10
Last Update Date:2020-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13080101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty