Provider Demographics
NPI:1215261185
Name:YOUNG, CHASTITY NICOLE (LPC LMFT)
Entity type:Individual
Prefix:MS
First Name:CHASTITY
Middle Name:NICOLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPC LMFT
Other - Prefix:
Other - First Name:C.
Other - Middle Name:NICOLE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC LMFT
Mailing Address - Street 1:100 FORDOCHE PL
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-1708
Mailing Address - Country:US
Mailing Address - Phone:985-778-4978
Mailing Address - Fax:
Practice Address - Street 1:312 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-3169
Practice Address - Country:US
Practice Address - Phone:985-778-4978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3868101YP2500X
LA1131106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist