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SOUTHLAKE CENTER FOR SELF DISCOVERY NPI 1366656910


NPI Information

NPI: 1366656910
Provider Name: SOUTHLAKE CENTER FOR SELF DISCOVERY
Classification: Social Worker - 1041C0700X
Entity Type: Organization

Specialization: Clinical

Address:
903 NORTHEAST DR STE 201
DAVIDSON, NC
ZIP 28036
Phone: (704) 896-7776
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SOUTHLAKE CENTER FOR SELF DISCOVERY is a clinical social worker in Davidson, NC. The provider is 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 interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. SOUTHLAKE CENTER FOR SELF DISCOVERY NPI is 1366656910. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

903 NORTHEAST DR STE 201
DAVIDSON, NC
ZIP 28036-438
Phone: (704) 896-7776
Fax: (704) 896-0992

The provider's authorized official is Kimberly Krueger .
The authorized official title is Owner Director and has the following contact phone number (704) 896-7776.

The enumeration date for this NPI number is 5/10/2007 and was last updated on 6/23/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11041C0700XSocial WorkerClinicalYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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