Provider Demographics
NPI:1225284086
Name:VARGAS, ANNIE ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:ELIZABETH
Last Name:VARGAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3783 GORDON ST
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:NC
Mailing Address - Zip Code:28682-9730
Mailing Address - Country:US
Mailing Address - Phone:704-677-6772
Mailing Address - Fax:704-626-3349
Practice Address - Street 1:127 N GREEN ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5375
Practice Address - Country:US
Practice Address - Phone:704-766-6772
Practice Address - Fax:704-626-3349
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NCC0076971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6009095Medicaid