MEDICARE: MAKING A DIFFERENCE MINISTRIES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1033408596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAKING A DIFFERENCE MINISTRIES

Provider Business Mailing Address
First Line	:	131 BYNUM PL
Second Line	:
City	:	NORLINA
State	:	NC
Zip	:	27563-9139
Country	:	US
Telephone Number	:	252-915-9104
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 HIGHWAY 158/401 BUSINESS
Second Line	:
City	:	NORLINA
State	:	NC
Zip	:	27563-9139
Country	:	US
Telephone Number	:	252-915-9104
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MOORE H BYNUM
Credential	:
Telephone Number	:	252-915-9104

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	04/05/2011

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Directions to “MAKING A DIFFERENCE MINISTRIES ” Practice Location

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