Provider Demographics
NPI:1013752641
Name:YOUNG, TYKARA SHANIQUE (LCSWA)
Entity type:Individual
Prefix:
First Name:TYKARA
Middle Name:SHANIQUE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14608
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4608
Mailing Address - Country:US
Mailing Address - Phone:800-632-1400
Mailing Address - Fax:
Practice Address - Street 1:604 MEADOW ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6600
Practice Address - Country:US
Practice Address - Phone:800-632-1400
Practice Address - Fax:336-690-5428
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP01836261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical