Healthcare Provider Details

I. General information

NPI: 1528111929
Provider Name (Legal Business Name): PAUL D. VEACH LMFT, LCAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 KILSON DR STE 202
MOORESVILLE NC
28117-8183
US

IV. Provider business mailing address

107 KILSON DR STE 202
MOORESVILLE NC
28117-8183
US

V. Phone/Fax

Practice location:
  • Phone: 704-660-8321
  • Fax: 704-660-8323
Mailing address:
  • Phone: 704-660-8321
  • Fax: 704-660-8323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number928
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1810
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: