Provider Demographics
NPI:1558874610
Name:MOHANTY-BARNES, ANITA ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:ELIZABETH
Last Name:MOHANTY-BARNES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:ELIZABETH
Other - Last Name:MOHANTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSWA
Mailing Address - Street 1:2007 ALDBURY LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-6689
Mailing Address - Country:US
Mailing Address - Phone:252-617-9326
Mailing Address - Fax:
Practice Address - Street 1:1405A S GLENBURNIE RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2603
Practice Address - Country:US
Practice Address - Phone:252-638-7875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-13
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NCP120781041C0700X
NCC0129911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC32-1160Medicaid