Provider Demographics
NPI:1831719376
Name:WEBSTER, ERNESTINE FUTRELL (LCSW)
Entity type:Individual
Prefix:
First Name:ERNESTINE
Middle Name:FUTRELL
Last Name:WEBSTER
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 1:642 MOUNT MORIAH RD
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-9336
Mailing Address - Country:US
Mailing Address - Phone:252-340-3832
Mailing Address - Fax:
Practice Address - Street 1:642 MOUNT MORIAH RD
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-9336
Practice Address - Country:US
Practice Address - Phone:252-340-3832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0119631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical