Provider Demographics
NPI:1033497490
Name:FRIEND, MICHAEL J (PHD CSAC ICADC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:FRIEND
Suffix:
Gender:M
Credentials:PHD CSAC ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 CLOVER DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-1604
Mailing Address - Country:US
Mailing Address - Phone:910-581-5210
Mailing Address - Fax:
Practice Address - Street 1:118 CHANEY AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-4805
Practice Address - Country:US
Practice Address - Phone:910-581-5210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NC799101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)