Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | R23685 | NC |
NPI | 1003573742 |
---|---|
Provider Name | John Scott |
First Address | Charlotte, NC 28211-1007 |
Second Address | Charlotte, NC 28211-1007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2021 |
Last Update Date | 17/11/2021 |