Basic Information
| Provider Information | |||||||||
| NPI: | 1881769818 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KERWIN | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 CHRISMILL LN | ||||||||
| Address2: | |||||||||
| City: | HOLLY SPRINGS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275409656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9312164943 | ||||||||
| FaxNumber: | 6154636603 | ||||||||
| Practice Location | |||||||||
| Address1: | 1517 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FUQUAY VARINA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275268579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9312164943 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2006 | ||||||||
| LastUpdateDate: | 05/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C004047 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.