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General NPI Number Information
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NPI Number | 1659589430
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Entity Type | Organization
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Legal Business Name | SHERMAN BERNARD BOONE
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 607 WASHINGTON ST
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City | WILLIAMSTON
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State | NC
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Zip | 27892-2645
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Country | US
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Telephone | 919-623-5502
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Fax |
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Provider Business Mailing Address
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Address Line | 1220 SOUTHGATE DR
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City | RALEIGH
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State | NC
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Zip | 27610-5095
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Country | US
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Telephone | 919-623-5502
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Fax |
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Authorized Official
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Title or Position | CEO,THERAPIST
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Name | SHERMAN BERNARD BOONE
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Credential | LCSW
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Telephone | 919-623-5502
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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 | C005669
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License Number State | NC
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