Healthcare Provider Details

I. General information

NPI: 1225582836
Provider Name (Legal Business Name): HENIRANNE HOPE MIXON MSW, LCSW-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 HAY ST
FAYETTEVILLE NC
28305-5313
US

IV. Provider business mailing address

911 HAY ST
FAYETTEVILLE NC
28305-5313
US

V. Phone/Fax

Practice location:
  • Phone: 910-438-0939
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP010579
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: