Healthcare Provider Details

I. General information

NPI: 1275295453
Provider Name (Legal Business Name): SESEN GEBREMARIAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8604 CLIFF CAMERON DR STE 152
CHARLOTTE NC
28269-8526
US

IV. Provider business mailing address

8604 CLIFF CAMERON DR STE 152
CHARLOTTE NC
28269-8526
US

V. Phone/Fax

Practice location:
  • Phone: 704-510-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP016850
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: