MEDICARE: DONNA E LAYTON LCSW, ACSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C006607	NC
2	1041S0200X	School Social Worker	C006607	NC

General Provider Information

NPI Number	:	1245525534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA E LAYTON LCSW, ACSW

Provider Business Mailing Address
First Line	:	1417 PAULONIA WAY
Second Line	:
City	:	MC LEANSVILLE
State	:	NC
Zip	:	27301-9806
Country	:	US
Telephone Number	:	336-285-7555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1417 PAULONIA WAY
Second Line	:
City	:	MC LEANSVILLE
State	:	NC
Zip	:	27301-9806
Country	:	US
Telephone Number	:	336-285-7555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2011
Last Update Date	:	06/14/2011

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