Healthcare Provider Details

I. General information

NPI: 1972333813
Provider Name (Legal Business Name): BEATRIZ GUADALUPE VELAZQUEZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 CROWNPOINT EXECUTIVE DR STE 100
CHARLOTTE NC
28227-6726
US

IV. Provider business mailing address

2400 CROWNPOINT EXECUTIVE DR STE 100
CHARLOTTE NC
28227-6726
US

V. Phone/Fax

Practice location:
  • Phone: 828-680-0466
  • Fax: 910-782-2026
Mailing address:
  • Phone: 828-680-0466
  • Fax: 910-782-2026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPO21136
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: