| Doctor Name: | TAMORA ELLEN YOUNG |
| NPI Number: | 1134294101 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC MAC |
| License Number: | LPC002129 |
| Business Practice Address: | 4396 Lawrenceville Rd Suite 104 Loganville, GA - 30052 |
| Business Phone Number: | 6783138784 |
| Business Fax Number: | 7705545584 |
| Mailing Address: | 4396 Lawrenceville Rd, Suite 104 LOGANVILLE |
| State: | GA |
| Postal Code: | 30052 |
| Phone Number: | 6783138784 |
| Fax Number: | 7705545584 |
| NPI Enumeration Date: | 11/22/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC002129 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |