Provider Demographics
NPI:1386773257
Name:YOUNG, JASON WILEY (PSYD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:WILEY
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 CLOISTER CT
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2207
Mailing Address - Country:US
Mailing Address - Phone:919-408-3212
Mailing Address - Fax:919-408-3306
Practice Address - Street 1:2435 LYNN RD.
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612
Practice Address - Country:US
Practice Address - Phone:919-408-3212
Practice Address - Fax:919-408-3306
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3275103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist