Healthcare Provider Details

I. General information

NPI: 1447310453
Provider Name (Legal Business Name): SUE ANNE WRENN L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 PARK RD SUITE 226
CHARLOTTE NC
28209-3650
US

IV. Provider business mailing address

5200 PARK RD SUITE 226
CHARLOTTE NC
28209-3650
US

V. Phone/Fax

Practice location:
  • Phone: 704-527-3077
  • Fax: 704-527-3078
Mailing address:
  • Phone: 704-527-3077
  • Fax: 704-527-3078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC001307
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: