MEDICARE: THALIA AVERY

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	P022995	NC

General Provider Information

NPI Number	:	1235089301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THALIA AVERY

Provider Business Mailing Address
First Line	:	2240 FLAXMERE RD APT 306
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-0319
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2240 FLAXMERE RD APT 306
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-0319
Country	:	US
Telephone Number	:	434-203-6362
Fax Number	:

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

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	01/29/2026

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Directions to “ THALIA AVERY ” Practice Location

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