Provider Demographics
NPI:1578043477
Name:MAKABIN, OCTOBER EVANS (LCSW(A)-1041C0700X)
Entity Type:Individual
Prefix:MRS
First Name:OCTOBER
Middle Name:EVANS
Last Name:MAKABIN
Suffix:
Gender:F
Credentials:LCSW(A)-1041C0700X
Other - Prefix:MRS
Other - First Name:OCTOBER
Other - Middle Name:EVANS
Other - Last Name:MAKABIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW(A)-1041C0700X
Mailing Address - Street 1:4121 CASTLETON RD APT A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2532
Mailing Address - Country:US
Mailing Address - Phone:980-365-0770
Mailing Address - Fax:
Practice Address - Street 1:327 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-6122
Practice Address - Country:US
Practice Address - Phone:828-695-5900
Practice Address - Fax:828-695-4256
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0127511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical