Basic Information
| Provider Information | |||||||||
| NPI: | 1609954213 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OFFENBERG | ||||||||
| FirstName: | SIGNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 NEW STATESIDE DR | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275161165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199422803 | ||||||||
| FaxNumber: | 9199422126 | ||||||||
| Practice Location | |||||||||
| Address1: | 355 C SOUTH MADISON BLVD | ||||||||
| Address2: | |||||||||
| City: | ROXBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365998366 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 12/10/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C005369 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 6106548 | 01 | NC | NC HEALTHCHOICE | OTHER | 388789 | 01 | NC | TRICARE | OTHER | 14341 | 01 | NC | BCBS | OTHER | 6106548 | 05 | NC | MEDICAID |