Healthcare Provider Details

I. General information

NPI: 1972173672
Provider Name (Legal Business Name): RUNY LEE THAO MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 EDGEWATER DR NW
CONOVER NC
28613-8184
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 828-464-0299
  • Fax:
Mailing address:
  • Phone: 704-730-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC018153
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: