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General NPI Number Information
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NPI Number | 1396500856
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Entity Type | Individual
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Provider Name | MICHAEL WARING CRILLY
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Gender | Male
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Dates
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Enumeration Date | 02/14/2024
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 1240 HUFFMAN MILL RD
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City | BURLINGTON
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State | NC
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Zip | 27215-8700
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Country | US
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Telephone | 336-430-6598
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Fax |
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Provider Business Mailing Address
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Address Line | 1502 OBAN CT
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City | MC LEANSVILLE
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State | NC
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Zip | 27301-9501
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Country | US
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Telephone | 661-433-8634
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 26672
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C016812
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License Number State | NC
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