Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 474 | SC |
Y | 103TC0700X | Clinical Psychologist | 474 | SC |
N | 102L00000X | Psychologist | 474 | SC |
N | 103T00000X | Psychologist | 474 | SC |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 474 | SC |
N | 103G00000X | Clinical Psychologist | 474 | SC |
N | 103TC0700X | Clinical Psychologist | 474 | SC |
N | 103TH0100X | Health Service | 474 | SC |
N | 103TP2701X | Group Psychotherapist | 474 | SC |
N | 103TR0400X | Rehabilitation Psychologist | 474 | SC |
NPI | 1013060813 |
---|---|
Provider Name | Craig Douglas Young |
First Address | Greenville, SC 29615-4536 |
Second Address | Greenville, SC 29601-2504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 26/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PS0263 | (05) | SC |