MEDICARE: TRANQUIL QUIETUDE, PLLC

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

General Provider Information

NPI Number	:	1780511857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANQUIL QUIETUDE, PLLC

Provider Business Mailing Address
First Line	:	1510 PEACHCROFT RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-2747
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	516 E 15TH ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28206-3480
Country	:	US
Telephone Number	:	704-964-6909
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. SHARISSE L MCGILL
Credential	:	LCSW
Telephone Number	:	704-964-6909

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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Directions to “TRANQUIL QUIETUDE, PLLC ” Practice Location

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