=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386495034
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IRIS SONJA PALIN LCSWA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2024
-----------------------------------------------------
Last Update Date | 04/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1724 ROXIE AVE
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28304-1623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-778-5900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3424 LEGION RD
-----------------------------------------------------
City | HOPE MILLS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28348-8472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-578-2854
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------