Provider Demographics
NPI:1992105795
Name:YOUNG, SERENITY (LGSW)
Entity type:Individual
Prefix:
First Name:SERENITY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 20TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-2610
Mailing Address - Country:US
Mailing Address - Phone:205-934-9715
Mailing Address - Fax:205-975-3795
Practice Address - Street 1:908 20TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-2610
Practice Address - Country:US
Practice Address - Phone:205-934-9715
Practice Address - Fax:205-975-3795
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3566G261QM0850X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health