Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 3310-A | NC |
Y | 101YM0800X | Mental Health Counselor | A10435 | NC |
N | 101YP2500X | Professional Counselor | A10435 | NC |
NPI | 1003252958 |
---|---|
Provider Name | Mr. John Sink Pulliam JR. |
First Address | Pinnacle, NC 27043 |
Second Address | Dobson, NC 27017-8825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2013 |
Last Update Date | 17/03/2018 |