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General NPI Number Information
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NPI Number | 1043921034
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Entity Type | Organization
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Legal Business Name | COMPLEMENT AND COMPLETE, PLLC
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Dates
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Enumeration Date | 12/09/2022
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Last Update Date | 12/09/2022
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Provider Practice Location Address
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Address Line | 2041 BUCKHILL ROAD
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City | GERRARDSTOWN
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State | WV
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Zip | 25420-2542
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Country | US
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Telephone | 951-264-0369
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Fax |
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Provider Business Mailing Address
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Address Line | 4800 EXPRESS DR. #19769 SMB#29685
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City | CHARLOTTE
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State | NC
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Zip | 28208
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Country | US
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Telephone | 910-216-4655
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DENETRA GARY
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Credential | LCSW, LCSW-C
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Telephone | 910-216-4655
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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 |
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License Number State |
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