=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477285104
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHEL MERRITT MARTIN MSW, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2022
-----------------------------------------------------
Last Update Date | 07/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5970 FAIRVIEW RD STE 126
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28210-2100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-762-1361
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5288 HICKORY KNOLL LN
-----------------------------------------------------
City | MOUNT HOLLY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28120-9339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-674-7673
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | C018759
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------