Provider Demographics
NPI:1265993604
Name:BOND, CHARMAINE YOLANDA (LCSW)
Entity type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:YOLANDA
Last Name:BOND
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 1:2600 CAMILLE DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9785
Mailing Address - Country:US
Mailing Address - Phone:252-258-2050
Mailing Address - Fax:
Practice Address - Street 1:600 MOYE BLVD
Practice Address - Street 2:VMC SUITE MA 333E
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-0001
Practice Address - Country:US
Practice Address - Phone:252-744-4905
Practice Address - Fax:252-744-8199
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0121141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC012114OtherNORTH CAROLINA SOCIAL WORK CERTIFICATION AND LICENSURE BOARD