Healthcare Provider Details

I. General information

NPI: 1750532800
Provider Name (Legal Business Name): BURKE COUNCIL ON ALCOHOLISM & CHEMICAL DEPENDENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 WHITE ST
MORGANTON NC
28655-3417
US

IV. Provider business mailing address

203 WHITE ST
MORGANTON NC
28655-3417
US

V. Phone/Fax

Practice location:
  • Phone: 828-433-1221
  • Fax: 828-433-1287
Mailing address:
  • Phone: 828-433-1221
  • Fax: 828-433-1287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number27G.3700
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6006610
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: JOE MARKS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 828-433-1221