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General NPI Number Information
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NPI Number | 1487957866
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Entity Type | Individual
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Provider Name | MELISSA MANGENE COWLES LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/07/2010
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Last Update Date | 12/07/2010
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Provider Practice Location Address
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Address Line | 1515 MOCKINGBIRD LN SUITE 1015
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City | CHARLOTTE
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State | NC
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Zip | 28209-3236
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Country | US
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Telephone | 704-525-3255
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Fax | 704-525-0949
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Provider Business Mailing Address
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Address Line | 1633 ROCKY GLEN LN
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City | CHARLOTTE
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State | NC
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Zip | 28214-8669
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Country | US
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Telephone | 301-466-4043
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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 | C005115
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License Number State | NC
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