Provider Demographics
NPI:1285168138
Name:YOUNG HEALING THERAPY LICENSED CLINICAL SOCIAL WORKER INC
Entity type:Organization
Organization Name:YOUNG HEALING THERAPY LICENSED CLINICAL SOCIAL WORKER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMATRA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:DOWNING
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PPSC
Authorized Official - Phone:877-905-5700
Mailing Address - Street 1:5028 GEARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2814
Mailing Address - Country:US
Mailing Address - Phone:877-905-5700
Mailing Address - Fax:844-334-9735
Practice Address - Street 1:5028 GEARY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-2814
Practice Address - Country:US
Practice Address - Phone:877-905-5700
Practice Address - Fax:844-334-9735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA269701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty