Provider Demographics
NPI:1831855063
Name:YOUNG, SHANNON (LICSW)
Entity type:Individual
Prefix:
First Name:SHANNON
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 1:1201 CONGRESS ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-4544
Mailing Address - Country:US
Mailing Address - Phone:262-880-4039
Mailing Address - Fax:
Practice Address - Street 1:1201 CONGRESS ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4544
Practice Address - Country:US
Practice Address - Phone:262-880-4039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500829411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical