=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649470865
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOANNA MICHELE GARCIA NUNEZ MSW, LCAS, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2007
-----------------------------------------------------
Last Update Date | 08/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 505B OWEN DR
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28304-3433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-483-0005
-----------------------------------------------------
Fax | 910-483-0045
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 262
-----------------------------------------------------
City | STEDMAN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28391-0262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-483-0005
-----------------------------------------------------
Fax | 910-483-0045
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | LCAS 1437
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | C006542
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------