Healthcare Provider Details

I. General information

NPI: 1780596023
Provider Name (Legal Business Name): PATRICK BRIAN IRVINE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 GRACE ST
KINGS MOUNTAIN NC
28086-2154
US

IV. Provider business mailing address

914 GRACE ST
KINGS MOUNTAIN NC
28086-2154
US

V. Phone/Fax

Practice location:
  • Phone: 252-339-0864
  • Fax:
Mailing address:
  • Phone: 252-339-0864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP024629
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: