Provider Demographics
NPI:1699092114
Name:YOUNG, ANDREA LEA (LPC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6005
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:TN
Mailing Address - Zip Code:37118-0105
Mailing Address - Country:US
Mailing Address - Phone:615-668-8877
Mailing Address - Fax:615-396-0541
Practice Address - Street 1:12017 MILTON ST # 6005
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:TN
Practice Address - Zip Code:37118-4320
Practice Address - Country:US
Practice Address - Phone:615-668-6677
Practice Address - Fax:615-691-6214
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2023-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3141101Y00000X, 101Y00000X, 101Y00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor