Healthcare Provider Details

I. General information

NPI: 1962795112
Provider Name (Legal Business Name): CHARMAINE REENADA DEES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2011
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2719 GRAVES DR STE 5
GOLDSBORO NC
27534-4536
US

IV. Provider business mailing address

211 W LOCKHAVEN DR APT C
GOLDSBORO NC
27534-1686
US

V. Phone/Fax

Practice location:
  • Phone: 919-330-4375
  • Fax:
Mailing address:
  • Phone: 336-314-2901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC006785
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: