Young, Staci M

Young, Staci M is an individual health care provider with primary practice located at 7025 Harbour View Blvd , Suffolk VA 23435-2761. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Young, Staci M can be contacted via phone (757) 434-6759.

Contact Information

Primary practice address
7025 Harbour View Blvd Suffolk VA 23435-2761
Phone: (757) 434-6759
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 0701004431 Virginia

Profile Details

NPI number 1144479379
LBN Legal business name Young, Staci M
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 11th, 2008
Last updated Mar 24th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144479379 NPPES
Virginia Other 0497717615 VA PREMIER MEDICAID HMO
Virginia Other 294721 VA PREMIER MEDICAID HMO
Virginia MEDICAID 1497717615 VA PREMIER MEDICAID HMO

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