Provider Demographics
NPI:1659664324
Name:MASSOL, JUANITA (LCSW,LCAS-A)
Entity Type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:
Last Name:MASSOL
Suffix:
Gender:F
Credentials:LCSW,LCAS-A
Other - Prefix:MS
Other - First Name:JUANITA
Other - Middle Name:
Other - Last Name:MASSOL-LOPEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1830 OWEN DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-1611
Mailing Address - Country:US
Mailing Address - Phone:910-273-1393
Mailing Address - Fax:
Practice Address - Street 1:1830 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-1611
Practice Address - Country:US
Practice Address - Phone:910-273-1393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3214-A101YA0400X
NCC0093181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)