Basic Information
| Provider Information | |||||||||
| NPI: | 1477036176 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | CHRISENDA | ||||||||
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| Credential: | LCAS-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4330 VIOLA SIPE DR | ||||||||
| Address2: | |||||||||
| City: | CONOVER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286138839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282563436 | ||||||||
| FaxNumber: | 8282563623 | ||||||||
| Practice Location | |||||||||
| Address1: | 929 15TH ST NE STE 100 | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286014162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283276026 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2018 | ||||||||
| LastUpdateDate: | 04/05/2019 | ||||||||
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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 | 101YA0400X | LCAS-24616 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.