Healthcare Provider Details

I. General information

NPI: 1114606183
Provider Name (Legal Business Name): AMAL MEBRAT LCMHC-A, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1914 BRUNSWICK AVE STE 1B
CHARLOTTE NC
28207-1891
US

IV. Provider business mailing address

1914 BRUNSWICK AVE STE 1B
CHARLOTTE NC
28207-1891
US

V. Phone/Fax

Practice location:
  • Phone: 704-910-2055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA19000
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: