Provider Demographics
NPI:1174664502
Name:LESTER, JOAN BARDIN (MSW MA IN CLINICAL P)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:BARDIN
Last Name:LESTER
Suffix:
Gender:F
Credentials:MSW MA IN CLINICAL P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5311 COLLINGSWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4363
Mailing Address - Country:US
Mailing Address - Phone:919-783-0833
Mailing Address - Fax:919-783-0833
Practice Address - Street 1:5311 COLLINGSWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4363
Practice Address - Country:US
Practice Address - Phone:919-783-0833
Practice Address - Fax:919-783-0833
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1310PSYCHOLOGICALASS103T00000X
NCC002329LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical