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 | 101YA0400X | Counselor | Addiction (Substance Use Disorder) | 101 | NORTH CAROLINA | No |
| 2 | 101YP2500X | Counselor | Professional | 635 | NORTH CAROLINA | 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 | 010699945 | OTHER | NORTH CAROLINA | HEALTHCARE SAVINGS -MGD. |
| 2 | 21190751354 | OTHER | NORTH CAROLINA | BEECH STREET - INS. |
| 3 | 7342103 | OTHER | NORTH CAROLINA | AETNA INC. - INSURANCE |
| 4 | 719313 | OTHER | NORTH CAROLINA | CCN - INS. |
| 5 | 6102026 | MEDICAID | NORTH CAROLINA | |
| 6 | 95160 | OTHER | NORTH CAROLINA | MEDCOST - 3RD PARTY ADM. |
| 7 | 149114 | OTHER | NORTH CAROLINA | VALUEOPTIONS - MGD. CARE |
| 8 | 010699945 | OTHER | NORTH CAROLINA | HORIZON BEH SERVICES -MGD |
| 9 | 294671 | OTHER | NORTH CAROLINA | AETNA U.S. HEALTHCARE INS |
| 10 | 294671 | OTHER | NORTH CAROLINA | MAGELLAN BEH. HEA. -MGD. |
| 11 | 32158-01 | OTHER | NORTH CAROLINA | CAROLINA BEH. HEA. ALLIAN |
| 12 | 188957 | OTHER | NORTH CAROLINA | COMPSYCH - MGD. CARE |
| 13 | 23625 | OTHER | NORTH CAROLINA | BLUE CROSS BLUE SHIELD |
| 14 | 5267686 | OTHER | NORTH CAROLINA | FIRSTHEALTH - INSURANCE |
| 15 | 010699945 | OTHER | NORTH CAROLINA | UNITED BEHAVIORAL HEALTH |
| 16 | 1053159 | OTHER | NORTH CAROLINA | CIGNA BEH. HEA.-MGD. CARE |
| 17 | 180615 | OTHER | NORTH CAROLINA | MANAGED HEALTH NETWORK |
