Healthcare Provider Details

I. General information

NPI: 1588430276
Provider Name (Legal Business Name): DUSTIN SADLOWSKI LCSW, LCAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 DUNSTAN RD
GREENSBORO NC
27405-9565
US

IV. Provider business mailing address

PO BOX 13890
GREENSBORO NC
27415-3890
US

V. Phone/Fax

Practice location:
  • Phone: 336-621-3381
  • Fax: 336-621-7513
Mailing address:
  • Phone: 336-621-3381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-27438
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC016351
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: