Provider Demographics
NPI:1760559470
Name:IRWIN, CLARA CONOVER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CLARA
Middle Name:CONOVER
Last Name:IRWIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 SPRINGBANK LN STE I
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3373
Mailing Address - Country:US
Mailing Address - Phone:704-333-2761
Mailing Address - Fax:
Practice Address - Street 1:3111 SPRINGBANK LN STE I
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3373
Practice Address - Country:US
Practice Address - Phone:704-333-2761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC002134101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2877444Medicare ID - Type Unspecified