Healthcare Provider Details

I. General information

NPI: 1548825433
Provider Name (Legal Business Name): DONNA KAYE SPIVEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 27TH ST
LUMBERTON NC
28358-3075
US

IV. Provider business mailing address

300 W 27TH ST
LUMBERTON NC
28358-3075
US

V. Phone/Fax

Practice location:
  • Phone: 910-671-5000
  • Fax: 910-671-8512
Mailing address:
  • Phone: 910-671-5000
  • Fax: 910-671-5852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC002560
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: