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General NPI Number Information
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NPI Number | 1043866734
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Entity Type | Individual
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Provider Name | DAVENA MGBEOKWERE LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/17/2019
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Last Update Date | 07/12/2022
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Provider Practice Location Address
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Address Line | 1235 EAST BLVD STE E-244
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City | CHARLOTTE
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State | NC
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Zip | 28203-5870
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Country | US
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Telephone | 704-251-9901
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Fax |
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Provider Business Mailing Address
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Address Line | 1235 EAST BLVD STE E-244
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City | CHARLOTTE
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State | NC
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Zip | 28203-5870
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Country | US
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Telephone | 704-802-2677
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C009807
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License Number State | NC
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