Provider Demographics
NPI:1114523008
Name:UZUKA, PRINCE U (LCAS-A)
Entity Type:Individual
Prefix:
First Name:PRINCE
Middle Name:U
Last Name:UZUKA
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 1:32 MERRIMAR CT
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-6065
Mailing Address - Country:US
Mailing Address - Phone:185-540-5144
Mailing Address - Fax:
Practice Address - Street 1:3709 NASH ST NW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1127
Practice Address - Country:US
Practice Address - Phone:185-540-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26064101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherN/A