Basic Information
Provider Information
NPI: 1730201484
EntityType: 2
ReplacementNPI:  
OrganizationName: DAYMARK RECOVERY SERVICES INC
LastName:  
FirstName:  
MiddleName:  
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Credential:  
OtherOrganizationName:  
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Mailing Information
Address1: 284 EXECUTIVE PARK DR STE 100
Address2:  
City: CONCORD
State: NC
PostalCode: 280251833
CountryCode: US
TelephoneNumber: 7049391100
FaxNumber: 7049391173
Practice Location
Address1: 650 HIGHLAND AVE STE 110
Address2:  
City: WINSTON SALEM
State: NC
PostalCode: 27101
CountryCode: US
TelephoneNumber: 3366078523
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/04/2007
LastUpdateDate: 10/29/2018
NPIDeactivationReasonCode:  
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NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: WEST
AuthorizedOfficialFirstName: BILLY
AuthorizedOfficialMiddleName: R
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 7049391100
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix: JR.
AuthorizedOfficialCredential: L.C.S.W.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251S00000X  Y AgenciesCommunity/Behavioral Health 

No ID Information.


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