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NPI Code Detail

MEDICARE: BRENDA WEGNER STUBBS MSW, LCSWA

MEDICARE: BRENDA WEGNER STUBBS MSW, 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
11041C0700XClinical Social WorkerP020246NC

General Provider Information

NPI Number : 1861241945
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENDA WEGNER STUBBS MSW, LCSWA
Provider Business Mailing Address
First Line : 30 NANDINA DR
Second Line :
City : GREENSBORO
State : NC
Zip : 27455-2766
Country : US
Telephone Number : 336-580-1779
Fax Number :
Provider Business Practice Location Address
First Line : 3000 BETHESDA PL STE 501
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27103-3327
Country : US
Telephone Number : 336-580-1779
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2024
Last Update Date : 05/13/2024

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