Provider Demographics
NPI:1932852605
Name:YOUNG, NICHOLAS KRISTOPHER (MSW, MDIV, LMSW)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:KRISTOPHER
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MSW, MDIV, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4717 BOOSA ST
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-5272
Mailing Address - Country:US
Mailing Address - Phone:240-688-8501
Mailing Address - Fax:
Practice Address - Street 1:4717 BOOSA ST
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-5272
Practice Address - Country:US
Practice Address - Phone:240-688-8501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28218104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker