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NPI Code Detail

MEDICARE: CLAIRE AFT NCC, LCMHCA

MEDICARE: CLAIRE AFT NCC, LCMHCA
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
1101YM0800XMental Health CounselorA20303NC

General Provider Information

NPI Number : 1205664158
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLAIRE AFT NCC, LCMHCA
Provider Business Mailing Address
First Line : 107 BROOKLEIGH CT
Second Line :
City : TRINITY
State : NC
Zip : 27370-9359
Country : US
Telephone Number : 336-970-7676
Fax Number :
Provider Business Practice Location Address
First Line : 3000 BETHESDA PL STE 501
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27103-3327
Country : US
Telephone Number : 336-332-2277
Fax Number : 336-346-8444
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2024
Last Update Date : 07/23/2024

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