Healthcare Provider Details

I. General information

NPI: 1225910417
Provider Name (Legal Business Name): SELAMAWIT ASRAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7208 ROCKWOOD FOREST LN
CHARLOTTE NC
28212-6462
US

IV. Provider business mailing address

7302 SNOWBIRD CT
MINT HILL NC
28227-7873
US

V. Phone/Fax

Practice location:
  • Phone: 314-520-9766
  • Fax:
Mailing address:
  • Phone: 314-520-9677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: