Healthcare Provider Details

I. General information

NPI: 1811935547
Provider Name (Legal Business Name): FLORENCE E MEHALIC MSSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E WATER ST
PLYMOUTH NC
27962-1330
US

IV. Provider business mailing address

300 W HARGETT ST APT 638
RALEIGH NC
27601-1591
US

V. Phone/Fax

Practice location:
  • Phone: 252-793-6500
  • Fax:
Mailing address:
  • Phone: 919-618-1955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0068981
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: