Healthcare Provider Details

I. General information

NPI: 1871977082
Provider Name (Legal Business Name): JESSICA HERBIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 FULTON ST
DURHAM NC
27705-3875
US

IV. Provider business mailing address

616 CHALCEDONY CT
DURHAM NC
27703-2691
US

V. Phone/Fax

Practice location:
  • Phone: 919-899-6259
  • Fax:
Mailing address:
  • Phone: 336-215-8651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC009148
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: