Healthcare Provider Details

I. General information

NPI: 1295192516
Provider Name (Legal Business Name): ANNA LIERSAPH L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2016
Last Update Date: 01/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8045 CORPORATE CENTER DR
CHARLOTTE NC
28226-4555
US

IV. Provider business mailing address

8045 CORPORATE CENTER DR
CHARLOTTE NC
28226-4555
US

V. Phone/Fax

Practice location:
  • Phone: 704-733-9010
  • Fax: 980-238-2151
Mailing address:
  • Phone: 704-733-9010
  • Fax: 980-238-2151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8601
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: