Provider Demographics
NPI:1720156292
Name:YOUNG, MICHELE (LICSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6186 BIRKEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2202
Mailing Address - Country:US
Mailing Address - Phone:304-736-6264
Mailing Address - Fax:304-736-4852
Practice Address - Street 1:6186 BIRKEWOOD RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2202
Practice Address - Country:US
Practice Address - Phone:304-736-6264
Practice Address - Fax:304-736-4852
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP004521431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical