Provider Demographics
NPI:1306434568
Name:HERRINGTON, ISRAEL (LCAS-A)
Entity type:Individual
Prefix:
First Name:ISRAEL
Middle Name:
Last Name:HERRINGTON
Suffix:
Gender:M
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 W MEADOWVIEW RD STE 109
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-3401
Mailing Address - Country:US
Mailing Address - Phone:336-763-2023
Mailing Address - Fax:
Practice Address - Street 1:2216 W MEADOWVIEW RD STE 109
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3401
Practice Address - Country:US
Practice Address - Phone:336-763-2023
Practice Address - Fax:336-763-2603
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-26536101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty