Provider Demographics
NPI:1457317505
Name:MCPHERSON, LORI ETHERIDGE (MSW, CMSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ETHERIDGE
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:MSW, CMSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1988 BOWLES AVE
Mailing Address - Street 2:
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-7823
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-383-6107
Practice Address - Fax:919-383-6128
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCSW0000006862104100000X
NCP002883104100000X
NCC0066201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker