Individual
MR. GEORGE ALBERT BACON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCMHCS, LCAS
Contact information
Practice address
2201 SEAGRAVE DR, WINTERVILLE, NC 28590-0119
(252) 341-2761
Mailing address
2201 SEAGRAVE DR, WINTERVILLE, NC 28590-0119
(252) 341-2761
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
S9005
NC
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCAS-2748
NC
Other
Enumeration date
09/22/2022
Last updated
09/23/2022
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