Provider Demographics
NPI:1992033666
Name:MIGOMBO, CALEB JONATHAN (P-LCSW)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:JONATHAN
Last Name:MIGOMBO
Suffix:
Gender:M
Credentials:P-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 FOUNTAIN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-2330
Mailing Address - Country:US
Mailing Address - Phone:919-433-6070
Mailing Address - Fax:
Practice Address - Street 1:355C-2 S. MADISON BLVD
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27273
Practice Address - Country:US
Practice Address - Phone:336-597-2065
Practice Address - Fax:336-597-2067
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical