Provider Demographics
NPI:1659778199
Name:MACEMORE, CHRISTOPHER JAMES (MS, LCAS-A)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:JAMES
Last Name:MACEMORE
Suffix:
Gender:M
Credentials:MS, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 DARNELL AVE
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-8853
Mailing Address - Country:US
Mailing Address - Phone:336-426-5092
Mailing Address - Fax:
Practice Address - Street 1:275 DARNELL AVE
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-8853
Practice Address - Country:US
Practice Address - Phone:336-428-7386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-27
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-23958101YA0400X
ZZ190101YP1600X
NC101YP1600X
NC1154673174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral