Provider Demographics
NPI:1831435585
Name:YOUNG, GWENDOLYN (MS)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3374SEASIDE RD
Mailing Address - Street 2:
Mailing Address - City:EXMORE
Mailing Address - State:VA
Mailing Address - Zip Code:23350-4642
Mailing Address - Country:US
Mailing Address - Phone:757-607-6960
Mailing Address - Fax:
Practice Address - Street 1:35615 BELLE HAVEN RD
Practice Address - Street 2:
Practice Address - City:BELLE HAVEN
Practice Address - State:VA
Practice Address - Zip Code:23306-1224
Practice Address - Country:US
Practice Address - Phone:757-678-3628
Practice Address - Fax:757-678-6955
Is Sole Proprietor?:No
Enumeration Date:2012-12-28
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0707070527101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health