Provider Demographics
NPI:1265906960
Name:YOUNG-LAWAL, D'NETRA LATRICE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:D'NETRA
Middle Name:LATRICE
Last Name:YOUNG-LAWAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31044-3642
Mailing Address - Country:US
Mailing Address - Phone:478-957-6283
Mailing Address - Fax:
Practice Address - Street 1:224 MAIN ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:31044-3642
Practice Address - Country:US
Practice Address - Phone:478-957-6283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0074571041C0700X
GAMSW007080104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker