Individual
MIRIAM O'BANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCASA
Contact information
Practice address
132 COMMERCIAL DR, SUITE 120, FOREST CITY, NC 28043-2400
(828) 248-1117
Mailing address
4685 HACKBERRY GROVE CIR, APT 1827, CHARLOTTE, NC 28269-2431
(706) 631-0570
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2130A
NC
Other
Enumeration date
02/02/2015
Last updated
02/02/2015
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