Provider Demographics
NPI:1821623000
Name:SCYOC, KEVIN REID (CEO, PM-C, COHC, RMA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:REID
Last Name:SCYOC
Suffix:
Gender:M
Credentials:CEO, PM-C, COHC, RMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 WESTERN BLVD STE 122
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7637
Mailing Address - Country:US
Mailing Address - Phone:910-333-0283
Mailing Address - Fax:910-333-0513
Practice Address - Street 1:461 WESTERN BLVD STE 122
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7637
Practice Address - Country:US
Practice Address - Phone:910-333-0283
Practice Address - Fax:910-333-0513
Is Sole Proprietor?:No
Enumeration Date:2020-03-07
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCON99XS11X5101YA0400X
NCADCK9AERA5101YP2500X
NC497657237700000X, 246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist