Healthcare Provider Details

I. General information

NPI: 1730872524
Provider Name (Legal Business Name): AHREAELLE TATIANNA MILLIKEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8535 CLIFF CAMERON DR STE 100
CHARLOTTE NC
28269-5909
US

IV. Provider business mailing address

8535 CLIFF CAMERON DR STE 100
CHARLOTTE NC
28269-5909
US

V. Phone/Fax

Practice location:
  • Phone: 704-717-7477
  • Fax: 704-717-7457
Mailing address:
  • Phone: 252-908-1542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP018864
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: