Healthcare Provider Details

I. General information

NPI: 1619043148
Provider Name (Legal Business Name): GERTRUDE H LIERMAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7810 BALLANTYNE COMMONS PKWY SUITE 300
CHARLOTTE NC
28277
US

IV. Provider business mailing address

7000 LENHART DRIVE
CHARLOTTE NC
28226
US

V. Phone/Fax

Practice location:
  • Phone: 704-607-5264
  • Fax:
Mailing address:
  • Phone: 704-341-2154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC30887
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1103
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: