Provider Demographics
NPI:1972899532
Name:BOBBY WEST MSW, LCSW PLLC
Entity Type:Organization
Organization Name:BOBBY WEST MSW, LCSW PLLC
Other - Org Name:BOBBY WEST
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:NEWELL
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:919-395-4614
Mailing Address - Street 1:1145 EXECUTIVE CIR STE D
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4586
Mailing Address - Country:US
Mailing Address - Phone:919-395-4614
Mailing Address - Fax:919-882-8108
Practice Address - Street 1:1145 EXECUTIVE CIR
Practice Address - Street 2:SUITE D
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4586
Practice Address - Country:US
Practice Address - Phone:919-395-4614
Practice Address - Fax:919-882-8109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2012-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0044441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003511Medicaid