Provider Demographics
NPI:1750611174
Name:YOUNGQUIST, ANNALISA (LPC)
Entity type:Individual
Prefix:
First Name:ANNALISA
Middle Name:
Last Name:YOUNGQUIST
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 BONNIEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8960
Mailing Address - Country:US
Mailing Address - Phone:919-780-8335
Mailing Address - Fax:
Practice Address - Street 1:108 BONNIEWOOD DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8960
Practice Address - Country:US
Practice Address - Phone:919-780-8335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7733101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional