Provider Demographics
NPI:1356483713
Name:RAUSCHER, PAUL ALAN (LCAS)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ALAN
Last Name:RAUSCHER
Suffix:
Gender:M
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 STATE FARM RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4996
Mailing Address - Country:US
Mailing Address - Phone:828-262-3382
Mailing Address - Fax:828-262-0899
Practice Address - Street 1:820 STATE FARM RD
Practice Address - Street 2:SUITE E
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4996
Practice Address - Country:US
Practice Address - Phone:828-262-3382
Practice Address - Fax:828-262-0899
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC916101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005474Medicaid
NC6005475Medicaid