Healthcare Provider Details

I. General information

NPI: 1508406406
Provider Name (Legal Business Name): MS. MICHELLE WORSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 07/11/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DESMOND DOSS HEALTH CLINIC ANNEX O
SCHOFIELD BARRACKS HI
28310-7324
US

IV. Provider business mailing address

2817 REILLY ST
FORT BRAGG NC
28310-7324
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-8601
  • Fax:
Mailing address:
  • Phone: 910-907-8697
  • Fax: 910-907-8631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC012809
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: