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General NPI Number Information
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NPI Number | 1003754375
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Entity Type | Individual
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Provider Name | MIRANDA GAVIN LCSWA
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Gender | Female
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Dates
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Enumeration Date | 03/24/2026
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Last Update Date | 03/24/2026
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Provider Practice Location Address
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Address Line | 10901 WORLD TRADE BLVD
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City | RALEIGH
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State | NC
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Zip | 27617-4203
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Country | US
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Telephone | 413-315-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 53 CATESBY TRL APT 301
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City | GARNER
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State | NC
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Zip | 27529-4493
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | P022687
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License Number State | NC
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