=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851271597
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. LUKE ADAM MOUNT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2025
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2406 MADISON DR
-----------------------------------------------------
City | NORTH MYRTLE BEACH
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29582-4334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-663-0747
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2406 MADISON DR
-----------------------------------------------------
City | NORTH MYRTLE BEACH
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29582-4334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
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 | LAC.938ACI
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------