Provider Information for 1194153122
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THANDIWE IRVIN TRUESDALE LCSW
Sex: Female
NPI: 1194153122
Last Updated: 2022-12-01
Certification Date: 2022-12-01
Certification Date: 2022-12-01
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1194153122 | ||||||||||||
| Enumeration Date | 2013-10-30 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 4919 ALBEMARLE RD STE 203 CHARLOTTE, NC 28205-6683 United States Phone: 980-495-6305 | Fax:980-495-6535 | ||||||||||||
| Primary Practice Address | 4919 ALBEMARLE RD STE 203 CHARLOTTE, NC 28205-6683 United States Phone: 980-495-6305 | Fax:980-495-6535 | ||||||||||||
| Secondary Practice Address(es) | 540 55TH ST. NE | ||||||||||||
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