Healthcare Provider Details

I. General information

NPI: 1982153599
Provider Name (Legal Business Name): ALBERTINE RENE' VISER MSW, LCSWA, LCASA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 01/21/2022
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 E FRANKLIN ST
MONROE NC
28112-5160
US

IV. Provider business mailing address

1408 E FRANKLIN ST
MONROE NC
28112-5160
US

V. Phone/Fax

Practice location:
  • Phone: 980-328-2492
  • Fax:
Mailing address:
  • Phone: 980-328-2492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP015660
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-26284
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: