Healthcare Provider Details

I. General information

NPI: 1487111506
Provider Name (Legal Business Name): STEPHANIE DEARMIN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15923 ROSE GLENN LN
DAVIDSON NC
28036-8920
US

IV. Provider business mailing address

15923 ROSE GLENN LN
DAVIDSON NC
28036-8920
US

V. Phone/Fax

Practice location:
  • Phone: 919-608-5622
  • Fax:
Mailing address:
  • Phone: 919-608-5622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC011904
License Number StateNC

VII. Legacy identifiers

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

# 1
Identifier0000000000
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerN/A

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: