| Carolyn Souders | |
|
4350 Main St Ste 213 Harrisburg NC 28075-7448 | |
| (267) 253-3063 | |
| Not Available |
| Full Name | Carolyn Souders |
|---|---|
| Speciality | Social Worker |
| Location | 4350 Main St Ste 213, Harrisburg, North Carolina |
| Authorized Official Name and Position | Carolyn Souders (OWNER/PROVIDER) |
| Authorized Official Contact | 2672533063 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carolyn Souders 10088 Dressage Ln Midland NC 28107-7515 Ph: (267) 253-3063 | Carolyn Souders 4350 Main St Ste 213 Harrisburg NC 28075-7448 Ph: (267) 253-3063 |
| NPI Number | 1932773033 |
|---|---|
| Provider Enumeration Date | 05/14/2021 |
| Last Update Date | 05/14/2021 |
| Certification Date | 05/14/2021 |
| Medicare PECOS PAC ID | 2466846126 |
|---|---|
| Medicare Enrollment ID | O20220223002856 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932773033 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Carolyn A Souders |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023365756 PECOS PAC ID: 4688937469 Enrollment ID: I20180409000658 |
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