Active NPI
Donald Mrdjenovic, CCS
- Addiction (Substance Use Disorder) Counselor
- Morehead City, NC
National Provider Identifier
1598811002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 251
- Practice address
- 3820 Bridges St
Ste B
Morehead City, NC 28557-2979 - Phone
- (252) 648-3124
- NPI assigned
- Jan 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 251 | NC | |
| Community/Behavioral Health Agency | 251S00000X | MHL-016-034 | NC | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 251 | NC | Primary |
Addresses
Primary practice location
3820 Bridges St
Ste B
Morehead City, NC 28557-2979
Mailing address
113 Rochelle Dr
Apt. N-4
Morehead City, NC 28557-2664
Phone (252) 247-1109
Other practice location 1
105 N 10th Street
Suite 6
Morehead City, NC 28557
Phone (252) 247-1109
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6110564 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 251 | NC | MD | Counselor |
| MHL-016-034 | NC | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1538438400000",
"number": "1598811002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "113 ROCHELLE DR",
"address_2": "APT. N-4",
"city": "MOREHEAD CITY",
"state": "NC",
"postal_code": "285572664",
"telephone_number": "252-247-1109",
"fax_number": "252-247-1107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3820 BRIDGES ST",
"address_2": "STE B",
"city": "MOREHEAD CITY",
"state": "NC",
"postal_code": "285572979",
"telephone_number": "252-648-3124"
}
],
"practiceLocations": [
{
"address_1": "105 N 10th Street",
"address_2": "Suite 6",
"address_purpose": "LOCATION",
"city": "Morehead City",
"state": "NC",
"postal_code": "28557",
"country_code": "US",
"telephone_number": "252-247-1109",
"fax_number": "252-247-1107",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MRDJENOVIC",
"first_name": "DONALD",
"name_prefix": "Mr.",
"credential": "CCS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-26",
"last_updated": "2018-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NC",
"license": "251",
"primary": false
},
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "NC",
"license": "MHL-016-034",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NC",
"license": "251",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6110564",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Morehead City, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.