Individual
WALTER JASON YOUNG JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
QP
Contact information
Practice address
412 ROOK RD, CHARLOTTE, NC 28216-3199
(704) 713-5293
(980) 207-4791
Mailing address
412 ROOK RD, CHARLOTTE, NC 28216-3199
(704) 713-5293
(980) 207-4791
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-060-1441
NC
Other
Enumeration date
11/26/2019
Last updated
03/09/2020
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