Healthcare Provider Details

I. General information

NPI: 1427083864
Provider Name (Legal Business Name): CONNIE SUE ZMIJEWSKI LCMHC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 OLD CONCORD RD
CHARLOTTE NC
28213-3646
US

IV. Provider business mailing address

10001 OLD CONCORD RD
CHARLOTTE NC
28213-3646
US

V. Phone/Fax

Practice location:
  • Phone: 704-547-1483
  • Fax: 704-547-0052
Mailing address:
  • Phone: 704-547-1483
  • Fax: 704-547-0052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5371
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: