Healthcare Provider Details

I. General information

NPI: 1538310008
Provider Name (Legal Business Name): ANITA BURLESON JARRARD MSW, P-LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7907 BUCK DEANS RD
MIDDLESEX NC
27557-9380
US

IV. Provider business mailing address

601 WEBSTER DR N
WILSON NC
27893-1754
US

V. Phone/Fax

Practice location:
  • Phone: 252-235-2161
  • Fax:
Mailing address:
  • Phone: 252-289-7219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP004073
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: