Healthcare Provider Details

I. General information

NPI: 1417329632
Provider Name (Legal Business Name): SCOTT KORPIK TOPAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5417 S MIAMI BLVD SUITE B
DURHAM NC
27703-8445
US

IV. Provider business mailing address

3700 ECK DR
RALEIGH NC
27604-4034
US

V. Phone/Fax

Practice location:
  • Phone: 919-627-8829
  • Fax:
Mailing address:
  • Phone: 919-561-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberP009875
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberP009875
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP009875
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP009875
License Number StateNC

VIII. Authorized Official

Name: SCOTT KORPIK TOPAL
Title or Position: SOLE PROPRIETOR
Credential:
Phone: 919-561-2012