Provider Demographics
NPI:1578452579
Name:YOUNG, EUNICE URSULA (MED, CRC, LGPC)
Entity type:Individual
Prefix:MRS
First Name:EUNICE
Middle Name:URSULA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MED, CRC, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4253 SHAMROCK AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-6402
Mailing Address - Country:US
Mailing Address - Phone:240-413-3465
Mailing Address - Fax:
Practice Address - Street 1:3455 WILKENS AVE STE 209
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5265
Practice Address - Country:US
Practice Address - Phone:443-639-4930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP16412101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty