MEDICARE: MRS. CAROLE FELICIA BOMBARDIER LCSW, CHT

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	C001378	NC

General Provider Information

NPI Number	:	1396930160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLE FELICIA BOMBARDIER LCSW, CHT

Provider Business Mailing Address
First Line	:	PO BOX 706
Second Line	:
City	:	KANNAPOLIS
State	:	NC
Zip	:	28082-0706
Country	:	US
Telephone Number	:	704-796-8542
Fax Number	:

Provider Business Practice Location Address
First Line	:	10225 HICKORYWOOD HILL AVE
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-3430
Country	:	US
Telephone Number	:	704-796-8542
Fax Number	:

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

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	09/13/2007

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