Provider Demographics
NPI:1548631849
Name:DEYOUNG, MARY (LPC-A)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DEYOUNG
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 W US HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-8115
Mailing Address - Country:US
Mailing Address - Phone:828-837-0071
Mailing Address - Fax:
Practice Address - Street 1:750 W US HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-8115
Practice Address - Country:US
Practice Address - Phone:828-837-0071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11806101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional