Provider Demographics
NPI:1659713162
Name:SEPULVEDA, ERIC JAMES (CSAC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JAMES
Last Name:SEPULVEDA
Suffix:
Gender:M
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 TWIN SPIRES DR
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7456
Mailing Address - Country:US
Mailing Address - Phone:919-525-7827
Mailing Address - Fax:
Practice Address - Street 1:4611 TWIN SPIRES DR
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7456
Practice Address - Country:US
Practice Address - Phone:919-525-7827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2017-06-29
Deactivation Date:2014-10-28
Deactivation Code:
Reactivation Date:2017-06-29
Provider Licenses
StateLicense IDTaxonomies
NC2980101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)