Healthcare Provider Details

I. General information

NPI: 1134215536
Provider Name (Legal Business Name): CAROLYN SUE PAPE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAROLYN SUE GRACE LCSW

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7741 MARKET ST SUITE H
WILMINGTON NC
28411-8806
US

IV. Provider business mailing address

211 BAYFIELD DR
WILMINGTON NC
28411-8713
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-8424
  • Fax: 910-686-7770
Mailing address:
  • Phone: 910-319-3196
  • Fax: 910-319-3106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC005406
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: