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General NPI Number Information
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NPI Number | 1023589405
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Entity Type | Individual
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Provider Name | CONSTANCE ELAINE PERKINS LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/11/2018
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Last Update Date | 12/11/2018
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Provider Practice Location Address
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Address Line | 105 WAXHAW PROFESSIONAL PARK DR STE H
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City | WAXHAW
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State | NC
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Zip | 28173-5018
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Country | US
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Telephone | 704-256-0305
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Fax | 704-256-9968
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Provider Business Mailing Address
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Address Line | 9107 DARTINGTON LN
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City | WAXHAW
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State | NC
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Zip | 28173-6590
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Country | US
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Telephone | 203-231-9919
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C008924
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License Number State | NC
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