Basic Information
| Provider Information | |||||||||
| NPI: | 1366776197 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAYNOR | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | HINSON | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 751069 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282751069 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 905 JOHNS HOPKINS DR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278342056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527441406 | ||||||||
| FaxNumber: | 2527444243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2009 | ||||||||
| LastUpdateDate: | 12/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | P004666 | NC | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | C007366 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1366776197 | 05 | NC | MEDICAID | 19QSR | 01 | NC | BCBS OF NC | OTHER | Q57406A | 01 | NC | MEDICARE | OTHER |