Provider Demographics
NPI:1750325999
Name:STREET, PATRICIA H (LCAS CSAC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:H
Last Name:STREET
Suffix:
Gender:F
Credentials:LCAS CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 322
Mailing Address - Street 2:
Mailing Address - City:SPINDALE
Mailing Address - State:NC
Mailing Address - Zip Code:28160-0322
Mailing Address - Country:US
Mailing Address - Phone:828-286-0501
Mailing Address - Fax:828-286-1019
Practice Address - Street 1:202 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPINDALE
Practice Address - State:NC
Practice Address - Zip Code:28160-1514
Practice Address - Country:US
Practice Address - Phone:828-286-0501
Practice Address - Fax:828-286-1019
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC226101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
12957OtherBCBS
NC6111751Medicaid