Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | C007967 | NC |
NPI | 1003167784 |
---|---|
Provider Name | Ms. Katherine Sarah Rives |
First Address | Winston Salem, NC 27101-2939 |
Second Address | Winston Salem, NC 27101-2939 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2012 |
Last Update Date | 21/09/2012 |