Healthcare Provider Details

I. General information

NPI: 1376451997
Provider Name (Legal Business Name): ALBERTO VAZQUEZ LCSWA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 S MAIN ST
RAEFORD NC
28376-3238
US

IV. Provider business mailing address

9565 CLIFFDALE RD STE 226
FAYETTEVILLE NC
28304-5956
US

V. Phone/Fax

Practice location:
  • Phone: 910-209-4332
  • Fax:
Mailing address:
  • Phone: 910-309-8450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP024282
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: