Individual provider Active NPI

Sidney Miller Deramus, LCAS-A

  • Addiction (Substance Use Disorder) Counselor
  • Hickory, NC
National Provider Identifier
1619664232
Registry record updated May 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
LCAS-28751 Issued in NC
Practice address
929 15TH St NE Ste 100
Hickory, NC 28601-4162
Phone
(828) 327-6026
Fax
(828) 327-8796
NPI assigned
Apr 24, 2023
Last updated
May 10, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X LCAS-28751 NC Primary

Addresses

Primary practice location

929 15TH St NE Ste 100
Hickory, NC 28601-4162

Mailing address

4330 Viola Sipe Dr
Conover, NC 28613-8839
Phone (828) 256-3436

Other practice location 1

4330 Viola Sipe Dr
Conover, NC 28613-8839
Phone (828) 256-3436

Other practice location 2

929 15th St NE Ste 320
Hickory, NC 28601-4162
Phone (828) 327-6026

Other practice location 3

929 15th St NE Ste 310
Hickory, NC 28601-4162
Phone (828) 327-6026

Other practice location 4

929 15th St NE Ste 330
Hickory, NC 28601-4162
Phone (828) 327-6026

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

LicenseStateTypeSpecialty
LCAS-28751NCMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Clay Wilson & Associates Addiction (Substance Use Disorder) Past Accepting new patients
Clay, Wilson & Assocaites, Inc. Addiction (Substance Use Disorder) Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1682294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683676800000",
    "number": "1619664232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4330 VIOLA SIPE DR",
            "city": "CONOVER",
            "state": "NC",
            "postal_code": "286138839",
            "telephone_number": "828-256-3436",
            "fax_number": "828-327-8796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "929 15TH ST NE STE 100",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286014162",
            "telephone_number": "828-327-6026",
            "fax_number": "828-327-8796"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4330 Viola Sipe Dr",
            "address_purpose": "LOCATION",
            "city": "Conover",
            "state": "NC",
            "postal_code": "286138839",
            "country_code": "US",
            "telephone_number": "828-256-3436",
            "fax_number": "828-327-8796",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "929 15th St NE Ste 320",
            "address_purpose": "LOCATION",
            "city": "Hickory",
            "state": "NC",
            "postal_code": "286014162",
            "country_code": "US",
            "telephone_number": "828-327-6026",
            "fax_number": "828-327-8796",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "929 15th St NE Ste 310",
            "address_purpose": "LOCATION",
            "city": "Hickory",
            "state": "NC",
            "postal_code": "286014162",
            "country_code": "US",
            "telephone_number": "828-327-6026",
            "fax_number": "828-327-8796",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "929 15th St NE Ste 330",
            "address_purpose": "LOCATION",
            "city": "Hickory",
            "state": "NC",
            "postal_code": "286014162",
            "country_code": "US",
            "telephone_number": "828-327-6026",
            "fax_number": "828-327-8796",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DERAMUS",
        "first_name": "SIDNEY",
        "middle_name": "MILLER",
        "credential": "LCAS-A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-24",
        "last_updated": "2023-05-10",
        "certification_date": "2023-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-28751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hickory, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.