Healthcare Provider Details

I. General information

NPI: 1295084366
Provider Name (Legal Business Name): KIERRA EUNNICE THURMAN MSW, LCSW, LCAS-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6025 CARRARA PL APT 203
CHARLOTTE NC
28215-0831
US

IV. Provider business mailing address

6025 CARRARA PL APT 203
CHARLOTTE NC
28215-0831
US

V. Phone/Fax

Practice location:
  • Phone: 704-676-2820
  • Fax:
Mailing address:
  • Phone: 704-676-2820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC020142
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: