Provider Demographics
NPI:1609027937
Name:CASSIDY, NATHAN D (MA, LPC, LCAS, NCC)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:D
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:MA, LPC, LCAS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 SPRING GARDEN ST. UNIT 1
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403
Mailing Address - Country:US
Mailing Address - Phone:336-303-0174
Mailing Address - Fax:
Practice Address - Street 1:2706 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3657
Practice Address - Country:US
Practice Address - Phone:336-272-9990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3241101YA0400X
NC9257101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health