MEDICARE: ANNA KATHERINE DEPOLLO LCSWA, LCASA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCAS-29999	NC
2	1041C0700X	Clinical Social Worker	P020608	NC

General Provider Information

NPI Number	:	1841960333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA KATHERINE DEPOLLO LCSWA, LCASA

Provider Business Mailing Address
First Line	:	7200 FALLS OF NEUSE RD STE 300
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-5384
Country	:	US
Telephone Number	:	984-200-2780
Fax Number	:

Provider Business Practice Location Address
First Line	:	7200 FALLS OF NEUSE RD STE 300
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-5384
Country	:	US
Telephone Number	:	984-200-2780
Fax Number	:

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

Provider Enumeration Date	:	09/15/2021
Last Update Date	:	12/13/2024

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