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 | 103T00000X | Psychologist | | | | No |
2 | 104100000X | Social Worker | | | | No |
3 | 1041C0700X | Social Worker | Clinical | | | No |
4 | 251C00000X | Day Training, Developmentally Disabled Services | | | | No |
5 | 252Y00000X | Early Intervention Provider Agency | | | | No |
6 | 261QD1600X | Clinic/Center | Developmental Disabilities | | | No |
7 | 261QM0850X | Clinic/Center | Adult Mental Health | | | No |
8 | 261QR0401X | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | | | No |
9 | 311ZA0620X | Custodial Care Facility | Adult Care Home | | | No |
10 | 320800000X | Community Based Residential Treatment Facility, Mental Illness | | | | No |
11 | 320900000X | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | | | | No |
12 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | No |
13 | 385H00000X | Respite Care | | | | No |
14 | 385HR2060X | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities | | | No |
15 | 251S00000X | Community/Behavioral Health | | | | 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 | 3418880 | MEDICAID | NORTH CAROLINA | |
2 | 7806258 | MEDICAID | NORTH CAROLINA | |