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General NPI Number Information
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NPI Number | 1295251213
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Entity Type | Individual
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Provider Name | KASHMIA A FANNING MSW, LCSWA
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Gender | Female
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Dates
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Enumeration Date | 08/22/2017
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Last Update Date | 03/22/2021
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Provider Practice Location Address
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Address Line | 233 S SHARON AMITY RD STE 102
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City | CHARLOTTE
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State | NC
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Zip | 28211-2893
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Country | US
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Telephone | 704-763-9555
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Fax |
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Provider Business Mailing Address
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Address Line | 8319 HARRIS POND DR APT H
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City | CHARLOTTE
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State | NC
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Zip | 28269-9313
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Country | US
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Telephone | 919-627-3065
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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 | P015813
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License Number State | NC
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