Healthcare Provider Details

I. General information

NPI: 1780619007
Provider Name (Legal Business Name): JEAN MARIE AYERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

6817 FAIRVIEW RD STE B
CHARLOTTE NC
28210-3598
US

IV. Provider business mailing address

6817 FAIRVIEW RD STE B
CHARLOTTE NC
28210-3598
US

V. Phone/Fax

Practice location:
  • Phone: 704-365-6260
  • Fax: 704-365-6266
Mailing address:
  • Phone: 704-365-6260
  • Fax: 704-365-6266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCOO4821
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904004688
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: