Healthcare Provider Details

I. General information

NPI: 1831064492
Provider Name (Legal Business Name): ASDYANE FRAGA LCMHC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 UNION ST S STE 200
CONCORD NC
28025-5098
US

IV. Provider business mailing address

11 UNION ST S STE 200
CONCORD NC
28025-5098
US

V. Phone/Fax

Practice location:
  • Phone: 704-918-9741
  • Fax: 704-270-6213
Mailing address:
  • Phone: 704-918-9741
  • Fax: 704-270-6213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22103
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: