Healthcare Provider Details

I. General information

NPI: 1487794830
Provider Name (Legal Business Name): ANNIE FAY MORRIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 06/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 SPRUCE ST W
WILSON NC
27893-3944
US

IV. Provider business mailing address

4004 TOWNES CT
WILSON NC
27896-8988
US

V. Phone/Fax

Practice location:
  • Phone: 252-230-6418
  • Fax: 252-234-7140
Mailing address:
  • Phone: 252-230-6418
  • Fax: 252-234-7140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC002760
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6002909
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
Identifier6002386
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 3
Identifier6002910
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: