Healthcare Provider Details

I. General information

NPI: 1619850013
Provider Name (Legal Business Name): MACY POOLE LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MAIN ST
BAYBORO NC
28515
US

IV. Provider business mailing address

5107 NC HIGHWAY 55 E
NEW BERN NC
28560-5162
US

V. Phone/Fax

Practice location:
  • Phone: 252-745-4510
  • Fax:
Mailing address:
  • Phone: 252-671-5894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP022536
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: