Healthcare Provider Details

I. General information

NPI: 1043866734
Provider Name (Legal Business Name): DAVENA MGBEOKWERE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2019
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 EAST BLVD STE E-244
CHARLOTTE NC
28203-5870
US

IV. Provider business mailing address

1235 EAST BLVD STE E-244
CHARLOTTE NC
28203-5870
US

V. Phone/Fax

Practice location:
  • Phone: 704-251-9901
  • Fax:
Mailing address:
  • Phone: 704-802-2677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC009807
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: