Healthcare Provider Details

I. General information

NPI: 1134304272
Provider Name (Legal Business Name): JOANNA MARY PATRONIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 WASHINGTON ST
CRAMERTON NC
28032-1221
US

IV. Provider business mailing address

608 WASHINGTON ST
CRAMERTON NC
28032-1221
US

V. Phone/Fax

Practice location:
  • Phone: 704-923-6783
  • Fax: 704-631-4765
Mailing address:
  • Phone: 704-923-6783
  • Fax: 704-631-4765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: