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NPI Code Detail

MEDICARE: DARRYL BLEVINS LCAS

MEDICARE: DARRYL BLEVINS LCAS
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
1101YA0400XAddiction (Substance Use Disorder) Counselor971NC

Other Identifiers

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

General Provider Information

NPI Number : 1568497253
Entity Type Code : Individual
Provider Name (Legal Business Name) : DARRYL BLEVINS LCAS
Provider Business Mailing Address
First Line : 1706 WAYNE MEMORIAL DR
Second Line :
City : GOLDSBORO
State : NC
Zip : 27534-2240
Country : US
Telephone Number : 919-734-6676
Fax Number : 919-734-9050
Provider Business Practice Location Address
First Line : 1706 WAYNE MEMORIAL DR
Second Line :
City : GOLDSBORO
State : NC
Zip : 27534-2240
Country : US
Telephone Number : 919-734-6676
Fax Number : 919-734-9050
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 07/08/2007

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