Basic Information
| Provider Information | |||||||||
| NPI: | 1205436284 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOLAR | ||||||||
| FirstName: | CYRUS | ||||||||
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| Credential: | MSW, LCSW, LCAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1121 N CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368327000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1121 N CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368327000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2020 | ||||||||
| LastUpdateDate: | 03/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LCAS-24156 | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | C012480 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.