Provider Demographics
NPI:1770680969
Name:NAGAISHI, YOSHICAZU D (MSW)
Entity Type:Individual
Prefix:
First Name:YOSHICAZU
Middle Name:D
Last Name:NAGAISHI
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:YOSHI
Other - Middle Name:
Other - Last Name:NAGAISHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:610 COLISEUM DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5325
Mailing Address - Country:US
Mailing Address - Phone:336-722-8173
Mailing Address - Fax:336-724-6491
Practice Address - Street 1:610 COLISEUM DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5325
Practice Address - Country:US
Practice Address - Phone:336-722-8173
Practice Address - Fax:336-724-6491
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC-0000681041C0700X
NC117106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC61759OtherBLUE CROSS/BLUE SHIELD
NC6003377Medicaid