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NPI Code Detail

MEDICARE: MR. HATTIE FAYE BORDEAUX LCSW

MEDICARE: MR. HATTIE FAYE BORDEAUX LCSW
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
11041C0700XClinical Social WorkerCOO1908NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1801997531
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. HATTIE FAYE BORDEAUX LCSW
Provider Business Mailing Address
First Line : 622 S MEMORIAL DR
Second Line :
City : GREENVILLE
State : NC
Zip : 27834-2854
Country : US
Telephone Number : 252-353-4250
Fax Number : 252-353-4228
Provider Business Practice Location Address
First Line : 622 S MEMORIAL DR
Second Line :
City : GREENVILLE
State : NC
Zip : 27834-2854
Country : US
Telephone Number : 252-353-4250
Fax Number : 252-353-4228
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2006
Last Update Date : 07/08/2007

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