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 | 101YP2500X | Counselor | Professional | | NORTH CAROLINA | No |
| 2 | 320600000X | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | | | | No |
| 3 | 320900000X | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | | | | No |
| 4 | 171M00000X | Case Manager/Care Coordinator | | | | No |
| 5 | 261QA0600X | Clinic/Center | Adult Day Care | | | No |
| 6 | 291U00000X | Clinical Medical Laboratory | | | | No |
| 7 | 311Z00000X | Custodial Care Facility | | | | No |
| 8 | 261QM0855X | Clinic/Center | Adolescent and Children Mental Health | | | No |
| 9 | 251S00000X | Community/Behavioral Health | | | | No |
| 10 | 207R00000X | Internal Medicine | | | NORTH CAROLINA | No |
| 11 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | No |
| 12 | 347C00000X | Private Vehicle | | | | Yes |
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 | 0 | MEDICAID | NORTH CAROLINA | |
| 2 | 90050524 | MEDICAID | SOUTH CAROLINA | |
