Provider Demographics
NPI:1407897077
Name:ENDRES, MARY JANE WILLIAMS (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JANE WILLIAMS
Last Name:ENDRES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 E GRAHAM ST
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-3336
Mailing Address - Country:US
Mailing Address - Phone:919-304-1223
Mailing Address - Fax:919-304-1223
Practice Address - Street 1:505 E GRAHAM ST
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-3336
Practice Address - Country:US
Practice Address - Phone:919-304-1223
Practice Address - Fax:919-304-1223
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0024671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106022Medicaid