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General NPI Number Information
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NPI Number | 1134567589
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Entity Type | Individual
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Provider Name | TERESA FATEMAH FENNELL MS LCSWA
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Gender | Female
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Dates
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Enumeration Date | 06/07/2013
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Last Update Date | 09/09/2013
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Provider Practice Location Address
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Address Line | 8801 J M KEYNES DR SUITE 440
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City | CHARLOTTE
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State | NC
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Zip | 28262-8436
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Country | US
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Telephone | 704-537-9551
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Fax |
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Provider Business Mailing Address
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Address Line | 12506 ATKINS CIRCLE DR APT 320
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City | CHARLOTTE
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State | NC
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Zip | 28277-0037
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Country | US
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Telephone | 704-726-3885
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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 | P007168
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License Number State | NC
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