Basic Information
Provider Information
NPI: 1578017307
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MACPHERSON
FirstName: BRITTLYNN
MiddleName: ROSE
NamePrefix:  
NameSuffix:  
Credential: LCSWA, LCASA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4300 SAPPHIRE CT STE 110
Address2:  
City: GREENVILLE
State: NC
PostalCode: 278349079
CountryCode: US
TelephoneNumber: 2528307540
FaxNumber: 2524130932
Practice Location
Address1: 3408 WILSHIRE BLVD
Address2: SUITE 100
City: WILMINGTON
State: NC
PostalCode: 284034339
CountryCode: US
TelephoneNumber: 9107636499
FaxNumber: 9106322355
Other Information
ProviderEnumerationDate: 08/10/2016
LastUpdateDate: 08/10/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XP010718NCY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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