Individual
MR. ROGER LEE YOUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S.,LCSW,LPC,CSAC
Contact information
Practice address
4105 SUNNYSIDE CRES, MADISON, WI 53704-3536
(608) 244-8802
Mailing address
4105 SUNNYSIDE CRES, MADISON, WI 53704-3536
(608) 244-8802
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
451-132
WI
101YP2500X
Professional Counselor
540-125
WI
1041C0700X
Clinical Social Worker
Primary
1300-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41001200
—
WI
Enumeration date
07/24/2007
Last updated
07/24/2007
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