Provider Demographics
NPI:1326793753
Name:ROY, NATHAN (LCMHC-A)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:ROY
Suffix:
Gender:M
Credentials:LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6073 CREEKVIEW CT
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-7586
Mailing Address - Country:US
Mailing Address - Phone:740-516-5954
Mailing Address - Fax:
Practice Address - Street 1:2353 CONCORD LAKE RD STE 160
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2892
Practice Address - Country:US
Practice Address - Phone:980-781-5856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17304101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health