Individual
MRS. CAROLYN TYREASE LONG-BANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1906 S MAIN ST STE 120, WAKE FOREST, NC 27587-5033
(919) 562-1080
(919) 570-3243
Mailing address
2601 DYKING RD, KITTRELL, NC 27544-8912
(757) 536-7564
(919) 570-3243
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
0904001830
VA
1041C0700X
Clinical Social Worker
Primary
C004810
NC
Other
Enumeration date
09/28/2006
Last updated
10/23/2018
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