Organization · Type 2 NPI

Primary Source Group, PLLC

Clinical Social Worker · Raleigh, NC

NPI number 1104052901 Active

Practice location

4905 Green Rd, Suite 105
Raleigh, NC 27616-2805

Call (919) 981-7373 Map

Fax (919) 981-7373

Mailing address

PO Box 58098
Raleigh, NC 27658-8098

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor 101YA0400X1222 (NC)
Psychologist 103T00000X1572 (NC)
Counseling Psychologist 103TC1900X865 (NC)
Clinical Social Worker Primary 1041C0700XC003663 (NC)

Clinical Social Worker: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpers…

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About NPI 1104052901

Primary Source Group, PLLC's National Provider Identifier is 1104052901, issued on Jun 8, 2009. The primary taxonomy on file is Clinical Social Worker (1041C0700X), and the practice location is in Raleigh, NC. The record was last updated on Jul 25, 2011.