Active NPI
Delores Dianne Young, LISAC
- Addiction (Substance Use Disorder) Counselor
- Surprise, AZ
National Provider Identifier
1891937116
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 11359
- Practice address
- 15270 W Brookside LN
Surprise, AZ 85374 - Phone
- (928) 231-1032
- NPI assigned
- Apr 1, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 11359 | AZ | Primary |
Addresses
Primary practice location
15270 W Brookside LN
Surprise, AZ 85374
Mailing address
1660 W Verde Dr
Wickenburg, AZ 85390
Phone (928) 231-1032
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101YA0400X | Other | AZ | COUNSELOR-ADDICTIONS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11359 | AZ | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1238544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1238544000000",
"number": "1891937116",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1660 W VERDE DR",
"city": "WICKENBURG",
"state": "AZ",
"postal_code": "85390",
"telephone_number": "928-231-1032"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15270 W BROOKSIDE LN",
"city": "SURPRISE",
"state": "AZ",
"postal_code": "85374",
"telephone_number": "928-231-1032"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "DELORES",
"middle_name": "DIANNE",
"credential": "LISAC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-04-01",
"last_updated": "2009-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "AZ",
"license": "11359",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COUNSELOR-ADDICTIONS",
"identifier": "101YA0400X",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Surprise, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.