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Individual
Inactive
Individual
Inactive
Sole proprietor
Provider details
NPI number
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C007366
NC
1041C0700X
Clinical Social Worker
P004666
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366776197
—
NC
01
—
19QSR
BCBS OF NC
NC
01
—
Q57406A
MEDICARE
NC
Enumeration date
—
Last updated
—
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