Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 101YM0800X | Counselor | Mental Health | | | No |
| 2 | 253Z00000X | In Home Supportive Care | | | | No |
| 3 | 374U00000X | Home Health Aide | | | | No |
| 4 | 343900000X | Non-emergency Medical Transport (VAN) | | | | No |
| 5 | 172V00000X | Community Health Worker | | | | No |
| 6 | 251S00000X | Community/Behavioral Health | | | | No |
| 7 | 372600000X | Adult Companion | | | | No |
| 8 | 372500000X | Chore Provider | | | | No |
| 9 | 376K00000X | Nurse's Aide | | | | Yes |
| 10 | 320900000X | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | | | | No |
| 11 | 106S00000X | Behavior Technician | | | | No |
| 12 | 101YA0400X | Counselor | Addiction (Substance Use Disorder) | | | No |
| 13 | 175T00000X | Peer Specialist | | | | No |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 1245656578 | MEDICAID | NORTH CAROLINA | |