Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 902 | NC |
Y | 1041C0700X | Clinical Social Worker | C004789 | NC |
NPI | 1003998311 |
---|---|
Provider Name | Debra Leigh Eng |
First Address | Apex, NC 27539-9745 |
Second Address | Raleigh, NC 27609-7390 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 11/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2873503A | MEDICARE PTAN (01) | NC |
6003424 | (05) | NC |