Provider Demographics
NPI:1649213679
Name:HOUGH, DAVID CLARK (LCSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CLARK
Last Name:HOUGH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3258 MISTY PINES RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-9011
Mailing Address - Country:US
Mailing Address - Phone:252-559-7450
Mailing Address - Fax:
Practice Address - Street 1:620 LYNNDALE CT
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5462
Practice Address - Country:US
Practice Address - Phone:252-559-7450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC-0003271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1056788OtherCIGNA
NC6002153Medicaid
NC44013OtherBLUECROSS/BLUE SHIELD
NC2860808AMedicare ID - Type UnspecifiedMEDICARE