Provider Demographics
NPI:1932152592
Name:MEWBORNE, JANICE ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:ANN
Last Name:MEWBORNE
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 1:714 OAKLAND ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3648
Mailing Address - Country:US
Mailing Address - Phone:828-692-0029
Mailing Address - Fax:828-692-0029
Practice Address - Street 1:714 OAKLAND ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3648
Practice Address - Country:US
Practice Address - Phone:828-692-0029
Practice Address - Fax:828-692-0029
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0005291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC55921OtherBCBSNC PROVIDER#
NCP00200238OtherRAILROAD MEDICARE PID#
NCC000529OtherNCSTATELICENSE#
NCC000529OtherNCSTATELICENSE#