MEDICARE: ESSENCE LINCOLN 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	1041C0700X	Clinical Social Worker	P021708	NC

General Provider Information

NPI Number	:	1841184280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESSENCE LINCOLN LCSWA

Provider Business Mailing Address
First Line	:	1740 HERITAGE CENTER DR STE 204
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-9849
Country	:	US
Telephone Number	:	984-235-7596
Fax Number	:	984-235-7054

Provider Business Practice Location Address
First Line	:	1744 HERITAGE CENTER DR STE 201
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-9853
Country	:	US
Telephone Number	:	984-235-7596
Fax Number	:	984-235-7054

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

Provider Enumeration Date	:	06/09/2025
Last Update Date	:	06/09/2025

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