Healthcare Provider Details

I. General information

NPI: 1790177368
Provider Name (Legal Business Name): TAMRA WITHERSPOON AGUILERA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E MEETING ST
MORGANTON NC
28655-3593
US

IV. Provider business mailing address

PO BOX 1536
MORGANTON NC
28680-1536
US

V. Phone/Fax

Practice location:
  • Phone: 828-437-3000
  • Fax:
Mailing address:
  • Phone: 828-437-3000
  • Fax: 828-437-4999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC0106791
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: