Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | C007384 | NC |
NPI | 1003191438 |
---|---|
Provider Name | Michael S Forrest |
First Address | Raleigh, NC 27612-3215 |
Second Address | Winston Salem, NC 27101-4206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2011 |
Last Update Date | 17/10/2011 |