Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | C007285 | NC |
Y | 1041C0700X | Clinical Social Worker | C007285 | NC |
NPI | 1003169202 |
---|---|
Provider Name | Ms. Bethany Dare Southern Morris |
First Address | Greensboro, NC 27401-1004 |
Second Address | Greensboro, NC 27403-1142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2012 |
Last Update Date | 13/08/2021 |