Provider Demographics
NPI:1982299137
Name:YOUNG-WATSON, SHELLEY D (LGPC)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:D
Last Name:YOUNG-WATSON
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9702 BOLTON ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1909
Mailing Address - Country:US
Mailing Address - Phone:410-258-4280
Mailing Address - Fax:
Practice Address - Street 1:9702 BOLTON ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1909
Practice Address - Country:US
Practice Address - Phone:410-258-4280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10512101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health