1265993604 NPI number — CHARMAINE YOLANDA BOND LCSW

Table of content: CHARMAINE YOLANDA BOND LCSW (NPI 1265993604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265993604 NPI number — CHARMAINE YOLANDA BOND LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOND
Provider First Name:
CHARMAINE
Provider Middle Name:
YOLANDA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265993604
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 CAMILLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTERVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28590-9785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-258-2050
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 MOYE BLVD
Provider Second Line Business Practice Location Address:
VMC SUITE MA 333E
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27834-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-744-4905
Provider Business Practice Location Address Fax Number:
252-744-8199
Provider Enumeration Date:
03/28/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C012114 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C012114 . This is a "NORTH CAROLINA SOCIAL WORK CERTIFICATION AND LICENSURE BOARD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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