Provider Demographics
NPI:1255057105
Name:YOUNG, CAROLINE VICTORIA (LP)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:VICTORIA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LP
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 35
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:SC
Mailing Address - Zip Code:29827-0035
Mailing Address - Country:US
Mailing Address - Phone:803-686-1219
Mailing Address - Fax:
Practice Address - Street 1:15720 BRIXHAM HILL AVE STE 150
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4785
Practice Address - Country:US
Practice Address - Phone:704-970-4791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6229103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical