MEDICARE: MS. STEPHANIE JO PIERRENOEL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C012876	NC
2	1041C0700X	Clinical Social Worker	13496	SC

General Provider Information

NPI Number	:	1184901902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE JO PIERRENOEL LCSW

Provider Business Mailing Address
First Line	:	PO BOX 748465
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-8465
Country	:	US
Telephone Number	:	855-284-7483
Fax Number	:	617-807-0958

Provider Business Practice Location Address
First Line	:	4412 PARK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3130
Country	:	US
Telephone Number	:	980-581-3061
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2011
Last Update Date	:	12/17/2025

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