MEDICARE: ANTRANIQUE NEBLETT MSW. LCSW

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

General Provider Information

NPI Number	:	1023386067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTRANIQUE NEBLETT MSW. LCSW

Provider Business Mailing Address
First Line	:	4651 CHARLOTTE PARK DR STE 101C
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-1916
Country	:	US
Telephone Number	:	704-251-5146
Fax Number	:	844-331-1422

Provider Business Practice Location Address
First Line	:	4651 CHARLOTTE PARK DR
Second Line	:	101C
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-1916
Country	:	US
Telephone Number	:	704-251-5146
Fax Number	:	844-331-1422

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

Provider Enumeration Date	:	12/05/2011
Last Update Date	:	03/07/2021

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