Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 20131 | NC |
Y | 101YM0800X | Mental Health Counselor | 8977 | NC |
N | 101YP2500X | Professional Counselor | 8977 | NC |
N | 103TM1800X | Intellectual & Developmental Disabilities | 00112424 | NC |
N | 103TR0400X | Rehabilitation Psychologist | 00112424 | NC |
NPI | 1063641397 |
---|---|
Provider Name | Mr. Sylvester R. Smith |
First Address | High Point, NC 27260-7369 |
Second Address | High Point, NC 27260-7369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2009 |
Last Update Date | 10/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6115154 | (05) | NC |
6115154 | NORTH CAROLINA HEALTH CHOICE (01) | NC |