Provider Demographics
NPI:1215468145
Name:YOUNG, TRACIE (LCSW-C)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 E CHURCHVILLE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3416
Mailing Address - Country:US
Mailing Address - Phone:443-640-4913
Mailing Address - Fax:443-640-4913
Practice Address - Street 1:1212 E CHURCHVILLE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3416
Practice Address - Country:US
Practice Address - Phone:443-640-4913
Practice Address - Fax:443-640-4913
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD167701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical