Healthcare Provider Details

I. General information

NPI: 1578043477
Provider Name (Legal Business Name): OCTOBER EVANS MAKABIN LCSW(A)-1041C0700X
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OCTOBER EVANS MAKABIN LCSW(A)-1041C0700X

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 1ST AVE NW
HICKORY NC
28601-6122
US

IV. Provider business mailing address

4121 CASTLETON RD APT A
CHARLOTTE NC
28211-2532
US

V. Phone/Fax

Practice location:
  • Phone: 828-695-5900
  • Fax: 828-695-4256
Mailing address:
  • Phone: 980-365-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP012751
License Number StateNC

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: