Provider Demographics
NPI:1356748933
Name:HART, JOHN T (MSW LCAS-A)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:T
Last Name:HART
Suffix:
Gender:M
Credentials:MSW LCAS-A
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:T
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 20354
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-0354
Mailing Address - Country:US
Mailing Address - Phone:919-998-8137
Mailing Address - Fax:
Practice Address - Street 1:1115-113 COVE BRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604
Practice Address - Country:US
Practice Address - Phone:919-998-8137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-26
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20034101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)