Basic Information
| Provider Information | |||||||||
| NPI: | 1437218849 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHA | ||||||||
| FirstName: | MI | ||||||||
| MiddleName: | YOUNG | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9249 HIGHWAY 29 S | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306016352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062274534 | ||||||||
| FaxNumber: | 7062274538 | ||||||||
| Practice Location | |||||||||
| Address1: | 9249 HIGHWAY 29 S | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306016352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062274534 | ||||||||
| FaxNumber: | 7062274538 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CSW003406 | GA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.