Provider Demographics
NPI:1982939104
Name:YOUNG, KIM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 OWEN DR STE 10-12
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-1611
Mailing Address - Country:US
Mailing Address - Phone:910-797-3022
Mailing Address - Fax:910-705-8184
Practice Address - Street 1:1830 OWEN DR STE 10-12
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-1611
Practice Address - Country:US
Practice Address - Phone:910-797-3302
Practice Address - Fax:910-705-8184
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ6421103TC0700X
NC5917103TC0700X
NC4735103T00000X
NY024245-01103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD589561802Medicaid