Individual
TRISTA S BRODIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4302 NC 210, SMITHFIELD, NC 27522-2752
(919) 609-9390
Mailing address
PO BOX 100, KNIGHTDALE, NC 27545-0100
(919) 609-9390
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
0000000000
NC
171M00000X
Case Manager/Care Coordinator
0000000000
NC
372600000X
Adult Companion
0000000000
NC
376J00000X
Homemaker
0000000000
NC
405300000X
Prevention Professional
0000000000
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1774
CODE
NC
Enumeration date
12/20/2018
Last updated
12/20/2018
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