Provider Demographics
NPI:1447010202
Name:YOUNG, LORETTA MARIE (BA,CADC)
Entity type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:MARIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:BA,CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2643 SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-1614
Mailing Address - Country:US
Mailing Address - Phone:773-701-2449
Mailing Address - Fax:
Practice Address - Street 1:3010 GRAND AVE FL 2
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2321
Practice Address - Country:US
Practice Address - Phone:847-377-8247
Practice Address - Fax:847-984-5805
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL28020101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health