Provider Demographics
NPI:1073614822
Name:CALHOUN, ROSEMARY GERTRUDE (MA)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:GERTRUDE
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-3826
Mailing Address - Country:US
Mailing Address - Phone:910-891-7062
Mailing Address - Fax:910-892-3764
Practice Address - Street 1:1505 US HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-7036
Practice Address - Country:US
Practice Address - Phone:910-693-2641
Practice Address - Fax:910-692-3489
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC800101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111818Medicaid
NC800OtherLCAS NUMBER