Provider Demographics
NPI:1902496003
Name:YOUNG, INDIA NICOLE (LLMSW)
Entity Type:Individual
Prefix:
First Name:INDIA
Middle Name:NICOLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 S COCHRAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1510
Mailing Address - Country:US
Mailing Address - Phone:517-325-9090
Mailing Address - Fax:517-325-9091
Practice Address - Street 1:128 S COCHRAN AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1510
Practice Address - Country:US
Practice Address - Phone:517-325-9090
Practice Address - Fax:517-325-9091
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical