Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | C008979 | NC |
NPI | 1003171216 |
---|---|
Provider Name | Denise Doster |
First Address | Charlotte, NC 28208-2472 |
Second Address | Charlotte, NC 28226-4558 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2012 |
Last Update Date | 01/03/2017 |