Individual
MR. JACK WILSON RHYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, LISW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
004880
SC
1041C0700X
Clinical Social Worker
C002180
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1255Y
BCBS
NC
05
—
405127
—
SC
05
—
SW1107
—
SC
Enumeration date
01/20/2006
Last updated
03/19/2024
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