Healthcare Provider Details

I. General information

NPI: 1689352379
Provider Name (Legal Business Name): CORINN MCKENZIE HOVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

769 N WENDOVER RD
CHARLOTTE NC
28211-1118
US

IV. Provider business mailing address

6800 SAINT PETERS LN
MATTHEWS NC
28105-8458
US

V. Phone/Fax

Practice location:
  • Phone: 704-376-7180
  • Fax:
Mailing address:
  • Phone: 704-654-6151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP019214
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: