Provider Demographics
NPI:1306909635
Name:YOUNG, GLORIA D
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:D
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:LIFELINE RECOVERY CENTER
Mailing Address - Street 2:PO BOX 7652
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-7652
Mailing Address - Country:US
Mailing Address - Phone:270-443-4743
Mailing Address - Fax:270-443-4717
Practice Address - Street 1:LIFELINE RECOVERY CENTER
Practice Address - Street 2:2806 MORGAN LANE
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001
Practice Address - Country:US
Practice Address - Phone:270-443-4743
Practice Address - Fax:270-443-4717
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKY-0491OtherCADC