Healthcare Provider Details

I. General information

NPI: 1548536485
Provider Name (Legal Business Name): TRACI MICHELA ABERNETHY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5209 W WENDOVER AVE
HIGH POINT NC
27265-9177
US

IV. Provider business mailing address

284 EXECUTIVE PARK DRIVE SUITE 100
CONCORD NC
28025-1894
US

V. Phone/Fax

Practice location:
  • Phone: 336-899-1550
  • Fax: 336-899-1589
Mailing address:
  • Phone: 704-939-1100
  • Fax: 704-939-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC008667
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: