Provider Demographics
NPI:1891250270
Name:YOUNG, KEVIN CHRISTOPHER (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:CHRISTOPHER
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11227 LOCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4554
Mailing Address - Country:US
Mailing Address - Phone:301-593-4040
Mailing Address - Fax:
Practice Address - Street 1:11227 LOCKWOOD DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4554
Practice Address - Country:US
Practice Address - Phone:301-593-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-10
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810006123103T00000X
MD06037103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD06037OtherMARYLAND BOARD OF PSYCHOLOGISTS
VA0810006123OtherVIRGINIA BOARD OF PSYCHOLOGISTS