Healthcare Provider Details

I. General information

NPI: 1598234155
Provider Name (Legal Business Name): MYTAJHA CHARBARNEAU RASCOE MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MYTAJHA RASCOE FREEMAN MSW, LCSW

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 BEDGOOD DR SW
WILSON NC
27893-8515
US

IV. Provider business mailing address

2416 BEDGOOD DR SW
WILSON NC
27893-8515
US

V. Phone/Fax

Practice location:
  • Phone: 252-265-9200
  • Fax: 252-237-8600
Mailing address:
  • Phone: 252-265-9200
  • Fax: 252-237-8600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC013610
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: