Healthcare Provider Details

I. General information

NPI: 1588352546
Provider Name (Legal Business Name): LEIA CHARNIN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3743 LATROBE DR
CHARLOTTE NC
28211-1164
US

IV. Provider business mailing address

3743 LATROBE DR
CHARLOTTE NC
28211-1164
US

V. Phone/Fax

Practice location:
  • Phone: 704-578-0585
  • Fax:
Mailing address:
  • Phone: 704-578-0585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. LEIA A CHARNIN
Title or Position: OWNDER
Credential: PHD
Phone: 704-578-0585