MEDICARE: MRS. PATRICIA DENISE BAGWELL LCMHC

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	101YM0800X	Mental Health Counselor	13544	NC

General Provider Information

NPI Number	:	1437751310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA DENISE BAGWELL LCMHC

Provider Business Mailing Address
First Line	:	3908 SIENA TER
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-9752
Country	:	US
Telephone Number	:	336-601-8025
Fax Number	:

Provider Business Practice Location Address
First Line	:	1931 NEW GARDEN RD STE 202
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-2558
Country	:	US
Telephone Number	:	336-339-1860
Fax Number	:

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

Provider Enumeration Date	:	11/15/2020
Last Update Date	:	06/22/2022

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