Provider Demographics
NPI:1356050587
Name:YOUNG, EBONY YVELLE (LCP)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:YVELLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-1699
Mailing Address - Country:US
Mailing Address - Phone:706-649-6500
Mailing Address - Fax:706-649-6521
Practice Address - Street 1:2022 15TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1699
Practice Address - Country:US
Practice Address - Phone:706-649-6500
Practice Address - Fax:706-649-6521
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013327101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional