45D2121097 CLIA NUMBER - CLINIC AT CC YOUNG, LLC

Laboratory Demographics

  • CLIA Code: 45D2121097
  • Facility Name: CLINIC AT CC YOUNG, LLC
  • Facility Address: 4847 W LAWTHER DRIVE, SUITE 100
    DALLAS, TX
    ZIP 75214
  • Facility Phone: 972 432-7874
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NICIA D. WASSON
  • NPI Number: 1104371442
  • Taxonomy: 207QA0505X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2121097
LAB Type Physician Office
Facility Name CLINIC AT CC YOUNG, LLC
Street 4847 W LAWTHER DRIVE, SUITE 100
City DALLAS
State TX
ZIP 75214
Phone 972 432-7874
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/31/2024
Certificate Expiration Date 10/30/2026
Facility Type Physician Office
Lab Director NICIA D. WASSON

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This page was last updated on: 9/29/2025