Provider Demographics
NPI:1063580173
Name:FORRIS, LORRAINE M (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:M
Last Name:FORRIS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 CULBRETH DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3639
Mailing Address - Country:US
Mailing Address - Phone:910-338-3737
Mailing Address - Fax:910-684-5649
Practice Address - Street 1:1213 CULBRETH DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3639
Practice Address - Country:US
Practice Address - Phone:910-338-3737
Practice Address - Fax:910-684-5649
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0005991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002509Medicaid
NCQ433310281OtherPALMETTO GBA