Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 104100000X | Social Worker |
NPI | 1003061045 |
---|---|
Provider Name | John B Callahan |
First Address | Carolina Beach, NC 28428-0540 |
Second Address | Carolina Beach, NC 28428 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2008 |
Last Update Date | 05/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4236690 | COMMISSION FOR CASE MANAGER CERTIFICATION (01) |