Provider Demographics
NPI:1194406751
Name:YOUNG, TAMMY
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
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 1:4393 KEVIN WALKER DR
Mailing Address - Street 2:# 1051
Mailing Address - City:MONTCLAIR
Mailing Address - State:VA
Mailing Address - Zip Code:22025-1636
Mailing Address - Country:US
Mailing Address - Phone:571-230-5782
Mailing Address - Fax:
Practice Address - Street 1:210 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:OCCOQUAN
Practice Address - State:VA
Practice Address - Zip Code:22125
Practice Address - Country:US
Practice Address - Phone:571-230-5782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701012700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional