Individual
BRIAN DISTASO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCMHC
Contact information
Practice address
855 SAM NEWELL RD STE 100, MATTHEWS, NC 28105-7593
(704) 360-3637
Mailing address
6016 STOREHOUSE RD, MINT HILL, NC 28227-9294
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
17591
NC
101YP2500X
Professional Counselor
17591
NC
Other
Enumeration date
08/16/2024
Last updated
10/10/2024
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