Provider Demographics
NPI:1841658978
Name:YOUNG, TIFFANY (MED,LPCA,NCC,NCCSC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MED,LPCA,NCC,NCCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2818 QUEEN CITY DR STE H
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-2736
Mailing Address - Country:US
Mailing Address - Phone:980-939-8009
Mailing Address - Fax:
Practice Address - Street 1:2818 QUEEN CITY DR STE H
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-2736
Practice Address - Country:US
Practice Address - Phone:980-939-8009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9319101YM0800X, 101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional