Provider Demographics
NPI:1972332096
Name:YOUNG, ERICA CHARMELLE (LMBT)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:CHARMELLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4258 NC HIGHWAY 49 S # 93
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-9702
Mailing Address - Country:US
Mailing Address - Phone:704-565-0262
Mailing Address - Fax:
Practice Address - Street 1:185 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4761
Practice Address - Country:US
Practice Address - Phone:704-565-0262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20229225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist