Healthcare Provider Details

I. General information

NPI: 1396885711
Provider Name (Legal Business Name): DAYMARK RECOVERY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 A SOUTH MAIN ST
LEXINGTON NC
27292-3134
US

IV. Provider business mailing address

284 EXECUTIVE PARK DRIVE SUITE 100
CONCORD NC
28025-1833
US

V. Phone/Fax

Practice location:
  • Phone: 336-242-2450
  • Fax: 336-249-9920
Mailing address:
  • Phone: 704-939-1100
  • Fax: 704-939-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberMHL-029-032
License Number StateNC

VIII. Authorized Official

Name: MR. BILLY R WEST JR.
Title or Position: PRESIDENT
Credential:
Phone: 704-939-1100