Healthcare Provider Details

I. General information

NPI: 1336897289
Provider Name (Legal Business Name): CHARLOTTE MORIEA LURCH WINSTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHARLOTTE MORIEA LURCH WINSTON LCSW

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 HIGHWAY 81 E UNIT 152
MCDONOUGH GA
30252-2978
US

IV. Provider business mailing address

922 HIGHWAY 81 E UNIT 152
MCDONOUGH GA
30252-2978
US

V. Phone/Fax

Practice location:
  • Phone: 470-571-2770
  • Fax:
Mailing address:
  • Phone: 770-401-9660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW007896
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: