Healthcare Provider Details

I. General information

NPI: 1053044644
Provider Name (Legal Business Name): REBECCA WOJCIECHOWSKI LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 SIKES PL STE 325
CHARLOTTE NC
28277-8208
US

IV. Provider business mailing address

10700 SIKES PL STE 325
CHARLOTTE NC
28277-8208
US

V. Phone/Fax

Practice location:
  • Phone: 707-247-7353
  • Fax:
Mailing address:
  • Phone: 704-247-7353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP017668
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: