MEDICARE: MS. CLARA CONOVER IRWIN L.C.S.W.

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	101YM0800X	Mental Health Counselor	C002134	NC

General Provider Information

NPI Number	:	1760559470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CLARA CONOVER IRWIN L.C.S.W.

Provider Business Mailing Address
First Line	:	3111 SPRINGBANK LN STE I
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-3373
Country	:	US
Telephone Number	:	704-333-2761
Fax Number	:

Provider Business Practice Location Address
First Line	:	3111 SPRINGBANK LN STE I
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-3373
Country	:	US
Telephone Number	:	704-333-2761
Fax Number	:

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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