Provider Demographics
NPI:1023883170
Name:YOUNG, KATINA D (RCSWI)
Entity type:Individual
Prefix:
First Name:KATINA
Middle Name:D
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11937 SUNBURST MARBLE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-2138
Mailing Address - Country:US
Mailing Address - Phone:847-970-1919
Mailing Address - Fax:
Practice Address - Street 1:11937 SUNBURST MARBLE RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-2138
Practice Address - Country:US
Practice Address - Phone:847-970-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL173911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical