Provider Demographics
NPI:1902580889
Name:YOUNG, DIAMOND R (LPC)
Entity Type:Individual
Prefix:
First Name:DIAMOND
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-1259
Mailing Address - Country:US
Mailing Address - Phone:618-447-6884
Mailing Address - Fax:
Practice Address - Street 1:933 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-1259
Practice Address - Country:US
Practice Address - Phone:618-447-6884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.019089101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional