MEDICARE: BURKE COUNCIL ON ALCOHOLISM AND CHEMICAL DEPENDENCY, INC

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	MHL-012-038	NC

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	:	1316397847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURKE COUNCIL ON ALCOHOLISM AND CHEMICAL DEPENDENCY, INC

Provider Business Mailing Address
First Line	:	203 WHITE ST
Second Line	:
City	:	MORGANTON
State	:	NC
Zip	:	28655-3417
Country	:	US
Telephone Number	:	828-433-1221
Fax Number	:	828-433-1287

Provider Business Practice Location Address
First Line	:	1013 WEST AVE NW
Second Line	:
City	:	LENOIR
State	:	NC
Zip	:	28645-5126
Country	:	US
Telephone Number	:	828-433-1221
Fax Number	:	828-433-1287

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JOE MARKS
Credential	:
Telephone Number	:	828-433-1221

Provider Enumeration Date	:	06/15/2016
Last Update Date	:	06/15/2016

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