Provider Demographics
NPI:1992373542
Name:YOUNG, CHRISTINA MARIE (LLMSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35379 POTTER ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:MI
Mailing Address - Zip Code:48041-4694
Mailing Address - Country:US
Mailing Address - Phone:586-567-4474
Mailing Address - Fax:
Practice Address - Street 1:35379 POTTER ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:MI
Practice Address - Zip Code:48041-4694
Practice Address - Country:US
Practice Address - Phone:586-567-4474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011098261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical