Provider Demographics
NPI:1922802461
Name:YOUNG, CARMEN NICOLE (NCE/NCSC)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:NICOLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:NCE/NCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-4521
Mailing Address - Country:US
Mailing Address - Phone:601-307-6536
Mailing Address - Fax:
Practice Address - Street 1:449 BROWN ST
Practice Address - Street 2:
Practice Address - City:PURVIS
Practice Address - State:MS
Practice Address - Zip Code:39401
Practice Address - Country:US
Practice Address - Phone:601-794-1097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS193676101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool