Provider Demographics
NPI:1750523825
Name:YOUNKINS, DIANE W (LCPC)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:W
Last Name:YOUNKINS
Suffix:
Gender:F
Credentials:LCPC
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 435
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:MD
Mailing Address - Zip Code:21755-0435
Mailing Address - Country:US
Mailing Address - Phone:301-834-9393
Mailing Address - Fax:301-834-9393
Practice Address - Street 1:703 W. PATRICK ST.
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701
Practice Address - Country:US
Practice Address - Phone:301-662-8908
Practice Address - Fax:301-791-5032
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4925101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty