Provider Demographics
NPI:1366458838
Name:DESIMONE, PATRICIA GRACE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:GRACE
Last Name:DESIMONE
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 1:47 OUTPOST LN
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28785-9518
Mailing Address - Country:US
Mailing Address - Phone:828-926-2605
Mailing Address - Fax:828-926-2605
Practice Address - Street 1:47 OUTPOST LN
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28785-9518
Practice Address - Country:US
Practice Address - Phone:828-926-2605
Practice Address - Fax:828-926-2605
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0039301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003458Medicaid
NC6003458Medicaid