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1609599711 NPI number — GEORGE ALBERT BACON JR. LCMHCS, LCAS

NPI Number: 1609599711
Health Care Provider/Practitioner: GEORGE ALBERT BACON JR. LCMHCS, LCAS

Information about “1609599711” NPI (GEORGE ALBERT BACON JR. LCMHCS, LCAS) exists in 1609599711 in HTML format HTML  |  1609599711 in plain Text format TXT  |  1609599711 in PDF (Portable Document Format) PDF  |  1609599711 in an XML format XML  formats.

NPI Number : 1609599711 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1609599711",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BACON",
    "FirstName": "GEORGE",
    "MiddleName": "ALBERT",
    "NamePrefix": "MR.",
    "NameSuffix": "JR.",
    "Credential": "LCMHCS, LCAS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2201 SEAGRAVE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WINTERVILLE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28590-0119",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "252-341-2761",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2201 SEAGRAVE DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WINTERVILLE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28590-0119",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "252-341-2761",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/22/2022",
    "LastUpdateDate": "09/23/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": "S9005",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "LCAS-2748",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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