Healthcare Provider Details

I. General information

NPI: 1306897244
Provider Name (Legal Business Name): MICHAEL ROBERT TROUT MA, MSW, LCAS, CCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3926 CUMBERLAND RD
FAYETTEVILLE NC
28306-2687
US

IV. Provider business mailing address

5623 LAWNWOOD DR
FAYETTEVILLE NC
28304-2016
US

V. Phone/Fax

Practice location:
  • Phone: 910-748-0061
  • Fax:
Mailing address:
  • Phone: 910-426-5299
  • Fax: 910-424-3078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number1212
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1212
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: