=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205444932
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPER MCDONALD LCASA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2020
-----------------------------------------------------
Last Update Date | 09/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12225 SOUTH CALEDONIA RD
-----------------------------------------------------
City | LAURINBURG
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-361-4398
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 295 ELLIS RD
-----------------------------------------------------
City | LUMBER BRIDGE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28357-8940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-322-2174
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | LCAS-23404
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 167G00000X
-----------------------------------------------------
Taxonomy Name | Licensed Psychiatric Technician
-----------------------------------------------------
License Number | 2023-177
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------