Provider Demographics
NPI:1386476497
Name:YOUNG, KRISTIN RAINE (LGSW)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:RAINE
Last Name:YOUNG
Suffix:
Gender:
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-5701
Mailing Address - Country:US
Mailing Address - Phone:304-516-2501
Mailing Address - Fax:
Practice Address - Street 1:34 COMMERCE DR STE 204
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-3896
Practice Address - Country:US
Practice Address - Phone:304-598-6066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00946960104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker