Provider Demographics
NPI:1316175201
Name:PERRY, JUSTIN LLOYD (LCSW, LCAS)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:LLOYD
Last Name:PERRY
Suffix:
Gender:M
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BILLINGSLEY ROAD
Mailing Address - Street 2:ANUVIA PREVENTION AND RECOVERY CENTER, INC.
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1072
Mailing Address - Country:US
Mailing Address - Phone:704-376-7447
Mailing Address - Fax:704-376-3384
Practice Address - Street 1:100 BILLINGSLEY ROAD
Practice Address - Street 2:ANUVIA PREVENTION AND RECOVERY CENTER, INC.
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1072
Practice Address - Country:US
Practice Address - Phone:704-376-7447
Practice Address - Fax:704-376-3384
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP005119101Y00000X
NCC007304101Y00000X
NC1529101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor