Provider Demographics
NPI:1912191636
Name:YOUNG, CHARLOTTE MILES (MS)
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:MILES
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1905
Mailing Address - Country:US
Mailing Address - Phone:207-667-8358
Mailing Address - Fax:
Practice Address - Street 1:56 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1905
Practice Address - Country:US
Practice Address - Phone:207-667-8358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMF1555106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist