Healthcare Provider Details

I. General information

NPI: 1043086895
Provider Name (Legal Business Name): MYA GARDNER LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MOORESVILLE RD
KANNAPOLIS NC
28081-0304
US

IV. Provider business mailing address

300 MOORESVILLE RD
KANNAPOLIS NC
28081-0304
US

V. Phone/Fax

Practice location:
  • Phone: 704-920-1199
  • Fax: 704-445-7508
Mailing address:
  • Phone: 704-920-1000
  • Fax: 704-934-4270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP019387
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: