Organization
INTEGRATED CARE OF GREATER HICKORY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS DAVID BLAKEMAN RMA (CHIEF ADMINISTRATION OFFICER)
(828) 322-5915
Entity
Organization
Contact information
Practice address
741 5TH ST SW, HICKORY, NC 28602
(828) 322-5915
Mailing address
741 5TH ST SW, HICKORY, NC 28602-3230
(828) 322-5915
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
207Q00000X
Family Medicine Physician
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8902716
—
NC
05
—
8973845
—
NC
Enumeration date
06/14/2018
Last updated
06/15/2018
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