Healthcare Provider Details

I. General information

NPI: 1780617902
Provider Name (Legal Business Name): KARA L EWING LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18121 W CATAWBA AVE
CORNELIUS NC
28031-5641
US

IV. Provider business mailing address

15602 GATHERING OAKS DR
HUNTERSVILLE NC
28078-5673
US

V. Phone/Fax

Practice location:
  • Phone: 704-235-1776
  • Fax:
Mailing address:
  • Phone: 704-235-1776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC004626
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: