Provider Demographics
NPI:1891504718
Name:YOUNG, ANTOINETTE B (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:ANTOINETTE
Middle Name:B
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:MS
Other - First Name:ANTOINETTE
Other - Middle Name:B
Other - Last Name:KIRKLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:5603 WOODBINE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1321
Mailing Address - Country:US
Mailing Address - Phone:215-820-0741
Mailing Address - Fax:
Practice Address - Street 1:5603 WOODBINE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1321
Practice Address - Country:US
Practice Address - Phone:215-820-0741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003213101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional