MEDICARE: MS. MAKEBA LARKIN CASEY MSW, LCSWA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	1041C0700X	Clinical Social Worker	P021711

General Provider Information

NPI Number	:	1306235700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAKEBA LARKIN CASEY MSW, LCSWA

Provider Business Mailing Address
First Line	:	4397 FEDERAL DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-8116
Country	:	US
Telephone Number	:	336-496-2838
Fax Number	:

Provider Business Practice Location Address
First Line	:	4397 FEDERAL DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-8116
Country	:	US
Telephone Number	:	336-496-2838
Fax Number	:

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

Provider Enumeration Date	:	01/22/2015
Last Update Date	:	03/25/2025

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