Provider Demographics
NPI:1841959434
Name:YOUNG, CORINNA EVON
Entity type:Individual
Prefix:
First Name:CORINNA
Middle Name:EVON
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 1:8801 FAST PARK DR STE 301
Mailing Address - Street 2:#1044
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-4853
Mailing Address - Country:US
Mailing Address - Phone:919-576-5569
Mailing Address - Fax:919-573-0768
Practice Address - Street 1:8801 FAST PARK DR.
Practice Address - Street 2:SUITE 301 #1044
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617
Practice Address - Country:US
Practice Address - Phone:919-576-5569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-11
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17153101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional