Provider Demographics
NPI:1154757722
Name:YOUNG, DELONTA
Entity type:Individual
Prefix:
First Name:DELONTA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3324 CURTIS DR.
Mailing Address - Street 2:#T1
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746
Mailing Address - Country:US
Mailing Address - Phone:202-292-9419
Mailing Address - Fax:
Practice Address - Street 1:3324 CURTIS DR
Practice Address - Street 2:T1
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-2658
Practice Address - Country:US
Practice Address - Phone:202-292-9419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health