Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 911 | NC |
Y | 101YP2500X | Professional Counselor | 3745 | NC |
NPI | 1003869314 |
---|---|
Provider Name | Mr. Richard Trent Codd III |
First Address | Asheville, NC 28805-2039 |
Second Address | Asheville, NC 28805-2039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 21/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12929 | NC BC/BS PROVIDER NUMBER (01) | NC |