=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316397847
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BURKE COUNCIL ON ALCOHOLISM AND CHEMICAL DEPENDENCY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2016
-----------------------------------------------------
Last Update Date | 06/15/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1013 WEST AVE NW
-----------------------------------------------------
City | LENOIR
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28645-5126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-433-1221
-----------------------------------------------------
Fax | 828-433-1287
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 203 WHITE ST
-----------------------------------------------------
City | MORGANTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28655-3417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-433-1221
-----------------------------------------------------
Fax | 828-433-1287
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. JOE MARKS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 828-433-1221
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | MHL-012-038
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------