Provider Demographics
NPI:1114551926
Name:NOCD NORTH CAROLINA PC
Entity type:Organization
Organization Name:NOCD NORTH CAROLINA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:828-424-3773
Mailing Address - Street 1:225 N MICHIGAN AVE STE 1430
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7653
Mailing Address - Country:US
Mailing Address - Phone:312-569-0820
Mailing Address - Fax:312-261-5080
Practice Address - Street 1:374 LAKEWIND DR
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-7448
Practice Address - Country:US
Practice Address - Phone:828-424-3773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty