Healthcare Provider Details

I. General information

NPI: 1619084035
Provider Name (Legal Business Name): SHARON CORBETT MUMFORD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

696 N SPENCE AVE STE B
GOLDSBORO NC
27534-4354
US

IV. Provider business mailing address

696 N SPENCE AVE STE B
GOLDSBORO NC
27534-4354
US

V. Phone/Fax

Practice location:
  • Phone: 919-583-8448
  • Fax: 919-583-8449
Mailing address:
  • Phone: 919-583-8448
  • Fax: 919-583-8449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC004835
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: