Provider Demographics
NPI:1598500480
Name:YOUNG, SOPHIA G (BA, MSA, MA)
Entity type:Individual
Prefix:MISS
First Name:SOPHIA
Middle Name:G
Last Name:YOUNG
Suffix:
Gender:F
Credentials:BA, MSA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15412 ROSEMONT MANOR DR
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-6240
Mailing Address - Country:US
Mailing Address - Phone:202-253-7798
Mailing Address - Fax:
Practice Address - Street 1:46553 VALLEY CT APT 6005
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-1851
Practice Address - Country:US
Practice Address - Phone:202-253-7798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251J00000X, 253Z00000X, 310400000X, 376J00000X, 385H00000X, 374U00000X, 171W00000X, 171400000X, 174200000X
MDL25136649251E00000X
MD251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care
No171W00000XOther Service ProvidersContractor
No171400000XOther Service ProvidersHealth & Wellness Coach
No174200000XOther Service ProvidersMeals