Provider Demographics
NPI:1982343653
Name:MCBROOM, CALLIE WALTON (MSW, LCSWA, CSW)
Entity Type:Individual
Prefix:MRS
First Name:CALLIE
Middle Name:WALTON
Last Name:MCBROOM
Suffix:
Gender:F
Credentials:MSW, LCSWA, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4985 HUNT RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-8850
Mailing Address - Country:US
Mailing Address - Phone:919-636-2034
Mailing Address - Fax:
Practice Address - Street 1:500 MILLSTONE DR STE 105
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-9055
Practice Address - Country:US
Practice Address - Phone:919-636-2034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPO179471041C0700X
NCA000690104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker