Provider Demographics
NPI:1528111929
Name:VEACH, PAUL D (LMFT, LCAS)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:D
Last Name:VEACH
Suffix:
Gender:M
Credentials:LMFT, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 KILSON DR STE 202
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8183
Mailing Address - Country:US
Mailing Address - Phone:704-660-8321
Mailing Address - Fax:704-660-8323
Practice Address - Street 1:107 KILSON DR STE 202
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8183
Practice Address - Country:US
Practice Address - Phone:704-660-8321
Practice Address - Fax:704-660-8323
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC928106H00000X
NC1810101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105079Medicaid