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NPI Code Detail

MEDICARE: MRS. VIDA ABBASI WACHOB L.C.S.W

MEDICARE: MRS. VIDA ABBASI WACHOB L.C.S.W
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 WorkerC000874NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
115008OTHERNCHEALTH DEPARTMENT

General Provider Information

NPI Number : 1922141340
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. VIDA ABBASI WACHOB L.C.S.W
Provider Business Mailing Address
First Line : 2845 BEATTIES FORD RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28216-3711
Country : US
Telephone Number : 704-446-7765
Fax Number :
Provider Business Practice Location Address
First Line : 2845 BEATTIES FORD RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28216-3711
Country : US
Telephone Number : 704-446-7765
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2007
Last Update Date : 07/08/2007

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