Provider Demographics
NPI:1952791261
Name:YOUNG, DAMIEN SEBASTIAN (MA, LMFT)
Entity Type:Individual
Prefix:MR
First Name:DAMIEN
Middle Name:SEBASTIAN
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4920
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-4920
Mailing Address - Country:US
Mailing Address - Phone:303-319-3616
Mailing Address - Fax:
Practice Address - Street 1:75-170 HUALALAI RD STE C311A
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1737
Practice Address - Country:US
Practice Address - Phone:808-480-1247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0001480106H00000X, 106H00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician