Provider Demographics
NPI:1437751310
Name:BAGWELL, PATRICIA DENISE (LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:DENISE
Last Name:BAGWELL
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 SIENA TER
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9752
Mailing Address - Country:US
Mailing Address - Phone:336-601-8025
Mailing Address - Fax:
Practice Address - Street 1:1931 NEW GARDEN RD STE 202
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2558
Practice Address - Country:US
Practice Address - Phone:336-339-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-15
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13544101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health