Provider Demographics
NPI:1962471136
Name:PARDUE, NANCY F (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:F
Last Name:PARDUE
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 1:1229 SPARTA RD
Mailing Address - Street 2:
Mailing Address - City:N WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-8093
Mailing Address - Country:US
Mailing Address - Phone:336-818-0661
Mailing Address - Fax:
Practice Address - Street 1:1260 COLLEGE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-2700
Practice Address - Country:US
Practice Address - Phone:336-469-7037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0016601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCN/AOtherCAROLINA BEHAVIORAL HEALT
NC6106246Medicaid
NCE1374OtherMEDCOST
NC6523KOtherBCBS OF NC
NC2864253Medicare ID - Type UnspecifiedPROVIDER ID #