MEDICARE: REESHONAW FARRISH LCSWA

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	P014908	NC

General Provider Information

NPI Number	:	1811504731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REESHONAW FARRISH LCSWA

Provider Business Mailing Address
First Line	:	319 S WESTGATE DR STE H
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1632
Country	:	US
Telephone Number	:	828-655-3113
Fax Number	:

Provider Business Practice Location Address
First Line	:	319 S WESTGATE DR STE H
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1632
Country	:	US
Telephone Number	:	828-655-3113
Fax Number	:

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

Provider Enumeration Date	:	09/24/2020
Last Update Date	:	09/28/2020

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