Healthcare Provider Details

I. General information

NPI: 1699728931
Provider Name (Legal Business Name): DAVID ALLEN HOPPE L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6809 FAIRVIEW RD
CHARLOTTE NC
28210-3336
US

IV. Provider business mailing address

6809 FAIRVIEW RD
CHARLOTTE NC
28210-3336
US

V. Phone/Fax

Practice location:
  • Phone: 704-365-7777
  • Fax: 704-365-9256
Mailing address:
  • Phone: 704-365-7777
  • Fax: 704-365-9256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC003639
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: