Provider Demographics
NPI:1578734232
Name:EBRON, EUGENE M (LCAS CCS SAP NCAC)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:M
Last Name:EBRON
Suffix:
Gender:M
Credentials:LCAS CCS SAP NCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5209 W WENDOVER AVE
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9177
Mailing Address - Country:US
Mailing Address - Phone:336-845-4006
Mailing Address - Fax:336-845-4001
Practice Address - Street 1:5209 W WENDOVER AVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-9177
Practice Address - Country:US
Practice Address - Phone:336-845-4006
Practice Address - Fax:336-845-4001
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC41101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health