Basic Information
| Provider Information | |||||||||
| NPI: | 1790384105 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YORK | ||||||||
| FirstName: | CASSIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 116 SEVEN MILE RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287148509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286828102 | ||||||||
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| Practice Location | |||||||||
| Address1: | 86 N MITCHELL AVE | ||||||||
| Address2: | |||||||||
| City: | BAKERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287056502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286882104 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2020 | ||||||||
| LastUpdateDate: | 06/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | A16326 | NC | N | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | LCAS-26773 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 1790384105 | 05 | NC | MEDICAID |