Individual
MERCIDA HAMPTON BANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAS-A
Contact information
Practice address
284 EXECUTIVE PARK DR STE 100, CONCORD, NC 28025-1833
(704) 939-1100
(704) 939-1173
Mailing address
284 EXECUTIVE PARK DR STE 100, CONCORD, NC 28025-1833
(704) 939-1100
(704) 939-1173
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
3209-A
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101YA0400X
—
NC
01
—
3209-A
PROVISIONAL LICENSED
NC
Enumeration date
04/19/2013
Last updated
04/07/2019
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