Provider Demographics
NPI:1487072641
Name:YOUNG, AMY DEANN (LPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:DEANN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 BEAVER DAM RD
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-4101
Mailing Address - Country:US
Mailing Address - Phone:770-530-7773
Mailing Address - Fax:
Practice Address - Street 1:6705 HIGHWAY 52 E STE C
Practice Address - Street 2:
Practice Address - City:MURRAYVILLE
Practice Address - State:GA
Practice Address - Zip Code:30564-2512
Practice Address - Country:US
Practice Address - Phone:770-530-7773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009932101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty