Basic Information
| Provider Information | |||||||||
| NPI: | 1386943421 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HASAN-HUSSEIN | ||||||||
| FirstName: | SINCERE | ||||||||
| MiddleName: | SALAM | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LPC, LCAS, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | WAMC 2817 REILEY RD | ||||||||
| Address2: | |||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283100001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109077568 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | WAMC 2817 REILEY RD | ||||||||
| Address2: | |||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283100001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109077568 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2011 | ||||||||
| LastUpdateDate: | 03/15/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 5200 | NC | N | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | 981 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.