Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 6801095611 | MI |
NPI | 1003257817 |
---|---|
Provider Name | Courtney Young |
First Address | Grand Rapids, MI 49505-5904 |
Second Address | Holland, MI 49423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2013 |
Last Update Date | 09/07/2013 |