Healthcare Provider Details

I. General information

NPI: 1811938210
Provider Name (Legal Business Name): CHAPEL HILL TRAINING OUTREACH PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 THOMPSON ST SUITE 204
PITTSBORO NC
27312-5653
US

IV. Provider business mailing address

35 THOMPSON ST SUITE 204
PITTSBORO NC
27312-5653
US

V. Phone/Fax

Practice location:
  • Phone: 919-542-9891
  • Fax:
Mailing address:
  • Phone: 919-542-9891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCOO3955
License Number StateNC

VIII. Authorized Official

Name: MS. JENNIFER ROTELLA
Title or Position: CLINICAL SOCIAL WORKER
Credential: MSW, LCSW
Phone: 919-542-9891