MEDICARE: DAYMARK RECOVERY SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	103T00000X	Psychologist
4	1041C0700X	Clinical Social Worker
5	2084P0800X	Psychiatry Physician
6	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013177492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAYMARK RECOVERY SERVICES INC

Provider Business Mailing Address
First Line	:	284 EXECUTIVE PARK DRIVE
Second Line	:	SUITE 100
City	:	CONCORD
State	:	NC
Zip	:	28025-1894
Country	:	US
Telephone Number	:	704-939-1100
Fax Number	:	704-939-1173

Provider Business Practice Location Address
First Line	:	701 E ROOSEVELT BLVD STE 600
Second Line	:
City	:	MONROE
State	:	NC
Zip	:	28112-4106
Country	:	US
Telephone Number	:	704-296-6200
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	BILLY R WEST JR.
Credential	:	MSW LCSW
Telephone Number	:	704-939-1100

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	06/12/2023

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