Healthcare Provider Details

I. General information

NPI: 1952012874
Provider Name (Legal Business Name): MARIBEL SOLEDAD HURTADO LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 01/04/2025
Certification Date: 01/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N STEELE ST STE 5
SANFORD NC
27330-3967
US

IV. Provider business mailing address

140 N STEELE ST STE 5
SANFORD NC
27330-3967
US

V. Phone/Fax

Practice location:
  • Phone: 919-253-5396
  • Fax:
Mailing address:
  • Phone: 192-535-3969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP018494
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: