Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 3528 | NC |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 3528-A | NC |
Y | 1041C0700X | Clinical Social Worker | C009802 | NC |
N | 1041C0700X | Clinical Social Worker | P008345 | NC |
NPI | 1003237785 |
---|---|
Provider Name | Peter Reich |
First Address | Greensboro, NC 27403-2148 |
Second Address | Greensboro, NC 27403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2013 |
Last Update Date | 31/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003237785 | (05) | NC |