Provider Demographics
NPI:1275605347
Name:IBRAHIM, NIVIEN (LCSW)
Entity Type:Individual
Prefix:
First Name:NIVIEN
Middle Name:
Last Name:IBRAHIM
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:PO BOX 1831
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27528-1831
Mailing Address - Country:US
Mailing Address - Phone:919-946-8644
Mailing Address - Fax:
Practice Address - Street 1:8838 US HIGHWAY 70 W
Practice Address - Street 2:SUITE 200C
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-4822
Practice Address - Country:US
Practice Address - Phone:919-946-8644
Practice Address - Fax:919-550-2913
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0041221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1415YOtherBCBS
NC6106317Medicaid
NC127852OtherMEDCOST
NC2852052Medicare PIN