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General NPI Number Information
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NPI Number | 1538735634
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Entity Type | Organization
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Legal Business Name | ASENCIO THERAPEUTIC SERVICES, PLLC
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Dates
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Enumeration Date | 05/28/2021
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Last Update Date | 05/28/2021
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Provider Practice Location Address
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Address Line | 7810 BALLANTYNE COMMONS PKWY STE 222
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City | CHARLOTTE
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State | NC
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Zip | 28277-3416
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Country | US
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Telephone | 704-672-0578
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Fax | 704-672-0726
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Provider Business Mailing Address
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Address Line | 318 HILLANDALE DR
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City | CHARLOTTE
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State | NC
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Zip | 28270-0994
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Country | US
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Telephone | 734-972-8970
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | CASSANDRA RHEA RONDEL ASENCIO
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Credential | LCSW
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Telephone | 704-672-0578
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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 |
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License Number State |
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