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General NPI Number Information
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NPI Number | 1225296726
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Entity Type | Individual
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Provider Name | LATINA ROSS MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 06/18/2010
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Provider Practice Location Address
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Address Line | 600 GREEN VALLEY RD
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City | GREENSBORO
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State | NC
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Zip | 27408-7700
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Country | US
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Telephone | 336-698-5257
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5716
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City | GREENSBORO
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State | NC
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Zip | 27405-9052
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | COO5957
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License Number State | NC
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