MEDICARE: MS. EARLENE KIMBERLY DUNBAR LICSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LC50080405	DC

General Provider Information

NPI Number	:	1114397767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EARLENE KIMBERLY DUNBAR LICSW, LCSW

Provider Business Mailing Address
First Line	:	227 W 4TH ST
Second Line	:	SUITE 228
City	:	CHARLOTTE
State	:	NC
Zip	:	28202-1545
Country	:	US
Telephone Number	:	704-606-8193
Fax Number	:

Provider Business Practice Location Address
First Line	:	64 NEW YORK AVE NE FL 3
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-3328
Country	:	US
Telephone Number	:	202-809-5471
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2015
Last Update Date	:	01/18/2022

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