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General NPI Number Information
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NPI Number | 1225549314
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Entity Type | Organization
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Legal Business Name | SYMMETRY HEALTH SERVICES PLLC
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Dates
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Enumeration Date | 10/17/2017
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Last Update Date | 09/06/2019
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Provider Practice Location Address
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Address Line | 501A WESTWOOD WAY
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City | LAURINBURG
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State | NC
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Zip | 28352-3459
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Country | US
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Telephone | 910-361-4522
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Fax | 910-361-4759
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Provider Business Mailing Address
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Address Line | PO BOX 2425
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City | LAURINBURG
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State | NC
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Zip | 28353-2425
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Country | US
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Telephone | 910-361-4522
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Fax | 910-361-4759
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Authorized Official
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Title or Position | OWNER
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Name | DENISE BOSTICK-FAIRLEY
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Credential | LCSW, LCASA, CCSOTS
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Telephone | 910-361-4522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCAS-22162
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C010965
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License Number State | NC
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