Healthcare Provider Details

I. General information

NPI: 1790772853
Provider Name (Legal Business Name): CYNTHIA B WESSINGER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10547 N MAIN ST
ARCHDALE NC
27263-2884
US

IV. Provider business mailing address

PO BOX 4776
ARCHDALE NC
27263-4776
US

V. Phone/Fax

Practice location:
  • Phone: 336-431-1888
  • Fax: 336-431-2217
Mailing address:
  • Phone: 336-431-1888
  • Fax: 336-431-2217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC001222
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: