Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | C009193 | NC |
NPI | 1003165747 |
---|---|
Provider Name | Caitlin Crolley Polk |
First Address | Baltimore, MD 21275-9194 |
Second Address | Asheville, NC 28806-2666 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2012 |
Last Update Date | 07/11/2014 |