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NPI Code Detail

MEDICARE: THOMAS W DUVALL JR. LCSW

MEDICARE: THOMAS W DUVALL JR. 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
11041C0700XClinical Social WorkerC004283NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336241959
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS W DUVALL JR. LCSW
Provider Business Mailing Address
First Line : 72 BLUE RIDGE LANE
Second Line :
City : BURNSVILLE
State : NC
Zip : 28714
Country : US
Telephone Number : 828-682-2111
Fax Number : 828-682-9323
Provider Business Practice Location Address
First Line : 72 BLUE RIDGE LN
Second Line :
City : BURNSVILLE
State : NC
Zip : 28714-7270
Country : US
Telephone Number : 828-682-2111
Fax Number : 828-682-9323
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2006
Last Update Date : 07/09/2007

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