MEDICARE: PORTIA WASHINGTON

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	104100000X	Social Worker	P014054	NC

General Provider Information

NPI Number	:	1699310557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PORTIA WASHINGTON

Provider Business Mailing Address
First Line	:	2260 S CHURCH ST STE 303
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-5389
Country	:	US
Telephone Number	:	336-538-6990
Fax Number	:

Provider Business Practice Location Address
First Line	:	2260 S CHURCH ST STE 303
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-5389
Country	:	US
Telephone Number	:	336-538-6990
Fax Number	:

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

Provider Enumeration Date	:	11/14/2019
Last Update Date	:	11/14/2019

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Directions to “ PORTIA WASHINGTON ” Practice Location

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