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Individual

CHRISTINE SUSAN MAIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW, LCAS

Contact information

Practice address
2003 GODWIN AVE, SUITE A, LUMBERTON, NC 28358-3149
(910) 739-8849
(910) 739-3197
Mailing address
3210 FAIRHILL DR, RALEIGH, NC 27612-3215
(919) 256-0824
(919) 256-0833

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
2083
NC
1041C0700X
Clinical Social Worker
Primary
C007922
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2083
LICENSE
NC
01
C007922
LICENSE
NC
Enumeration date
09/06/2012
Last updated
09/06/2012
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