Healthcare Provider Details

I. General information

NPI: 1689940967
Provider Name (Legal Business Name): SAMMI LEE ERVIN P-LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 EAST ST
ALBEMARLE NC
28001-3423
US

IV. Provider business mailing address

103 DOSETT DR STE 200
SALISBURY NC
28144-2278
US

V. Phone/Fax

Practice location:
  • Phone: 704-636-2059
  • Fax:
Mailing address:
  • Phone: 704-870-8108
  • Fax: 704-870-8110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP006737
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: