Provider Demographics
NPI:1134371834
Name:YOUNG, ELEANE LATONYA (LMFT 87673)
Entity type:Individual
Prefix:MS
First Name:ELEANE
Middle Name:LATONYA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LMFT 87673
Other - Prefix:
Other - First Name:ELEANE
Other - Middle Name:LATONYA
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT 0717001508
Mailing Address - Street 1:9327 MIDLOTHIAN TPKE STE 1D
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4965
Mailing Address - Country:US
Mailing Address - Phone:951-900-4414
Mailing Address - Fax:951-880-0817
Practice Address - Street 1:9327 MIDLOTHIAN TPKE STE 1D
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4965
Practice Address - Country:US
Practice Address - Phone:951-900-4414
Practice Address - Fax:951-880-0817
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CALMFT87673106H00000X
VA0717001508106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0717001508OtherVIRGINIA BOARD OF PSYCHOLOGY