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General NPI Number Information
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NPI Number | 1689904401
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Entity Type | Individual
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Provider Name | JACK A REGISTER II MSW, LCSW, LCAS
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Gender | Male
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Dates
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Enumeration Date | 12/29/2009
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 416 W RADIANCE DR
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City | GREENSBORO
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State | NC
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Zip | 27403-1228
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Country | US
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Telephone | 336-588-9156
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Fax |
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Provider Business Mailing Address
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Address Line | 416 W RADIANCE DR
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City | GREENSBORO
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State | NC
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Zip | 27403-1228
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Country | US
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Telephone | 336-588-9156
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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 | 1723
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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 | C004968
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License Number State | NC
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