=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962833764
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN CAPRELL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2013
-----------------------------------------------------
Last Update Date | 12/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 932 OLD US 70 W
-----------------------------------------------------
City | BLACK MOUNTAIN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28711-2547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-768-6741
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 665 W 4TH ST
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27101-2701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-768-6741
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNSELOR
-----------------------------------------------------
Name | JOHN SAMUL CAPRELL
-----------------------------------------------------
Credential | MA, LPCA, LCASA
-----------------------------------------------------
Telephone | 828-738-6741
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 2858-A
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------