Organization
CLUB NOVA COMMUNITY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN KINKAID DUNN (EXECUTIVE DIRECTOR)
(919) 968-6682
Entity
Organization
Contact information
Practice address
103 W MAIN ST STE D, CARRBORO, NC 27510-1691
(919) 968-6682
(919) 968-2522
Mailing address
PO BOX 1346, CARRBORO, NC 27510-3346
(919) 968-6682
(919) 968-2522
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C005810
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301156-B
—
NC
05
—
8301156-S
—
NC
Enumeration date
08/06/2009
Last updated
08/06/2009
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