Healthcare Provider Details

I. General information

NPI: 1881784288
Provider Name (Legal Business Name): LORRAINNE ALICE BILODEAU I LCAS, CCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 WOOD RIVER RD
WEST END NC
27376-8713
US

IV. Provider business mailing address

145 WOOD RIVER RD
WEST END NC
27376-8713
US

V. Phone/Fax

Practice location:
  • Phone: 910-638-4930
  • Fax: 910-295-2438
Mailing address:
  • Phone: 910-638-4930
  • Fax: 910-295-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number243
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: