Healthcare Provider Details

I. General information

NPI: 1548443286
Provider Name (Legal Business Name): CONNIE JANE NUMBERS LCSW, PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113B CAUSEWAY DRIVE
OCEAN ISLE BEACH NC
28469
US

IV. Provider business mailing address

2983 LAKE POINT DR SW
SUPPLY NC
28462-5951
US

V. Phone/Fax

Practice location:
  • Phone: 910-575-0088
  • Fax:
Mailing address:
  • Phone: 910-575-0088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCOO5826
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: