Healthcare Provider Details

I. General information

NPI: 1104506658
Provider Name (Legal Business Name): LARONDA BARKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E 7TH ST STE 7
CHARLOTTE NC
28204-2455
US

IV. Provider business mailing address

301 S MCDOWELL ST STE 125-1072
CHARLOTTE NC
28204-2623
US

V. Phone/Fax

Practice location:
  • Phone: 646-719-0445
  • Fax:
Mailing address:
  • Phone: 646-719-0445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number30459
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904020082
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC019848
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30459
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: