MEDICARE: MRS. T'HALESE MARIE STEEN LCSWA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	P020028	NC

General Provider Information

NPI Number	:	1023334174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. T'HALESE MARIE STEEN LCSWA

Provider Business Mailing Address
First Line	:	1011 SKIPJACK LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-4899
Country	:	US
Telephone Number	:	313-283-9261
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 SKIPJACK LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-4899
Country	:	US
Telephone Number	:	313-283-9261
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2010
Last Update Date	:	06/09/2026

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