Provider Demographics
NPI:1912938564
Name:WORM, JOHN S (MSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:WORM
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 3RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5014
Mailing Address - Country:US
Mailing Address - Phone:828-322-8736
Mailing Address - Fax:828-322-7890
Practice Address - Street 1:106 3RD AVE NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5014
Practice Address - Country:US
Practice Address - Phone:828-322-8736
Practice Address - Fax:828-322-7890
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0016871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical