Provider Demographics
NPI:1083964258
Name:ARMSTRONG, ETHAN (LCSWA)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:
Last Name:ARMSTRONG
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 FALSTAFF RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1813
Mailing Address - Country:US
Mailing Address - Phone:919-799-9919
Mailing Address - Fax:919-615-1027
Practice Address - Street 1:3012 FALSTAFF RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1813
Practice Address - Country:US
Practice Address - Phone:919-615-1027
Practice Address - Fax:919-615-1501
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0114581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical