Healthcare Provider Details

I. General information

NPI: 1730487406
Provider Name (Legal Business Name): CARRIE BEAVER ROSS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 11TH AVENUE DR SE
HICKORY NC
28602-8336
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 828-695-6585
  • Fax: 828-695-4729
Mailing address:
  • Phone: 704-874-9005
  • Fax: 704-874-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC007174
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: