MEDICARE: ROSELYN MCCOY 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	LCAS-25521	NC

General Provider Information

NPI Number	:	1841881422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSELYN MCCOY LCSWA

Provider Business Mailing Address
First Line	:	303 GREEN ST E
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-4105
Country	:	US
Telephone Number	:	252-243-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3826 STERLING POINTE DR # N6
Second Line	:
City	:	WINTERVILLE
State	:	NC
Zip	:	28590-8854
Country	:	US
Telephone Number	:	252-375-3650
Fax Number	:

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

Provider Enumeration Date	:	01/27/2021
Last Update Date	:	06/06/2024

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