Healthcare Provider Details

I. General information

NPI: 1528035409
Provider Name (Legal Business Name): MICHAEL DOUGLAS TOMPKINS LCAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 HWY 18 SOUTH
SPARTA NC
28675-8478
US

IV. Provider business mailing address

895 STATE FARM RD SUITE 508
BOONE NC
28607-4917
US

V. Phone/Fax

Practice location:
  • Phone: 336-372-4095
  • Fax: 828-262-5687
Mailing address:
  • Phone: 336-372-4095
  • Fax: 828-262-5687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number66
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: