Basic Information
| Provider Information | |||||||||
| NPI: | 1992874465 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | INMAN | ||||||||
| FirstName: | JOETTE | ||||||||
| MiddleName: | BUCCA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CSAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3036 PINEY MOUNTAIN DR | ||||||||
| Address2: | |||||||||
| City: | HOPE MILLS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283485710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109784313 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1329 ROBESON ST | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283055531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104380039 | ||||||||
| FaxNumber: | 9104380942 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 101YA0400X | 2105 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.