Healthcare Provider Details

I. General information

NPI: 1538519418
Provider Name (Legal Business Name): ANTONISHA FLOYD LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 VEAZEY RD
BUTNER NC
27509
US

IV. Provider business mailing address

300 VEAZEY RD
BUTNER NC
27509
US

V. Phone/Fax

Practice location:
  • Phone: 919-764-2000
  • Fax:
Mailing address:
  • Phone: 919-764-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP010444
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP010444
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: