Provider Demographics
NPI:1598234155
Name:RASCOE, MYTAJHA CHARBARNEAU (MSW, LCSW-A)
Entity Type:Individual
Prefix:
First Name:MYTAJHA
Middle Name:CHARBARNEAU
Last Name:RASCOE
Suffix:
Gender:F
Credentials:MSW, LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 EXECUTIVE CIR STE C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3744
Mailing Address - Country:US
Mailing Address - Phone:252-215-5704
Mailing Address - Fax:252-215-5701
Practice Address - Street 1:2313 EXECUTIVE CIR STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3744
Practice Address - Country:US
Practice Address - Phone:252-215-5704
Practice Address - Fax:252-215-5701
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical