Provider Demographics
NPI:1124296736
Name:YOUNGBLOOD, AMBER HARDISON (LPC)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:HARDISON
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 CRANSTON CROSSING PL
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-3697
Mailing Address - Country:US
Mailing Address - Phone:704-650-0343
Mailing Address - Fax:
Practice Address - Street 1:2004 CRANSTON CROSSING PL
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-3697
Practice Address - Country:US
Practice Address - Phone:704-650-0343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-16
Last Update Date:2008-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5542101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional