Provider Demographics
NPI:1306897244
Name:TROUT, MICHAEL ROBERT (MA, MSW, LCAS, CCS)
Entity type:Individual
Prefix:PROF
First Name:MICHAEL
Middle Name:ROBERT
Last Name:TROUT
Suffix:
Gender:M
Credentials:MA, MSW, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5623 LAWNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-2016
Mailing Address - Country:US
Mailing Address - Phone:910-426-5299
Mailing Address - Fax:910-424-3078
Practice Address - Street 1:3926 CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-2687
Practice Address - Country:US
Practice Address - Phone:910-748-0061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NC1212261QR0405X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111996Medicaid