Healthcare Provider Details

I. General information

NPI: 1841249091
Provider Name (Legal Business Name): PATRICIA OLIVER SPROUSE M.S., L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N SECOND ST
MEBANE NC
27302-2401
US

IV. Provider business mailing address

1606 W LAKEWOOD AVE
DURHAM NC
27707-1129
US

V. Phone/Fax

Practice location:
  • Phone: 919-923-6777
  • Fax:
Mailing address:
  • Phone: 919-923-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4787
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: