Provider Demographics
NPI:1700935962
Name:DUBBER, CAROLE EVANS (MSW LCSW)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:EVANS
Last Name:DUBBER
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:CAROLE
Other - Middle Name:EVANS
Other - Last Name:MACKIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1100 NAVAHO DRIVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609
Mailing Address - Country:US
Mailing Address - Phone:919-872-2987
Mailing Address - Fax:919-554-3030
Practice Address - Street 1:1100 NAVAHO DRIVE
Practice Address - Street 2:SUITE 114
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609
Practice Address - Country:US
Practice Address - Phone:919-872-2987
Practice Address - Fax:919-554-3030
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC000227104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
29206OtherBCBS
2867654Medicare ID - Type Unspecified