Provider Demographics
NPI:1194007146
Name:YOUNG, BRITTANNI T
Entity type:Individual
Prefix:MRS
First Name:BRITTANNI
Middle Name:T
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6916 MCGINNIS FERRY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1258
Mailing Address - Country:US
Mailing Address - Phone:678-347-2153
Mailing Address - Fax:678-680-5147
Practice Address - Street 1:6916 MCGINNIS FERRY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1258
Practice Address - Country:US
Practice Address - Phone:678-347-2153
Practice Address - Fax:678-680-5147
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001464106H00000X
SC4585106H00000X
FLIMT 2855106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCLT1023Medicaid