Provider Demographics
NPI:1992447742
Name:YOUNG, LUCAS DALE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:DALE
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12410 MILESTONE CENTER DR STE 600
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-7102
Mailing Address - Country:US
Mailing Address - Phone:301-828-2350
Mailing Address - Fax:301-828-2350
Practice Address - Street 1:12410 MILESTONE CENTER DR STE 600
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-7102
Practice Address - Country:US
Practice Address - Phone:301-828-2350
Practice Address - Fax:301-828-2350
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC004327363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health