Provider Demographics
NPI:1861228629
Name:SONG, YOUNG EUN
Entity type:Individual
Prefix:
First Name:YOUNG EUN
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MINA
Other - Middle Name:
Other - Last Name:SONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:430 W 9 MILE RD APT 210
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-3031
Mailing Address - Country:US
Mailing Address - Phone:714-356-0433
Mailing Address - Fax:
Practice Address - Street 1:5980 S MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2377
Practice Address - Country:US
Practice Address - Phone:248-625-2970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health