MEDICARE: MS. GLORIA COLTHARP MSW, LCSW, BCD, ACSW

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	C000431	NC

General Provider Information

NPI Number	:	1295947265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GLORIA COLTHARP MSW, LCSW, BCD, ACSW

Provider Business Mailing Address
First Line	:	PO BOX 217035
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28221-0035
Country	:	US
Telephone Number	:	704-372-0020
Fax Number	:	704-358-0876

Provider Business Practice Location Address
First Line	:	2237 PARK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-5922
Country	:	US
Telephone Number	:	704-372-0020
Fax Number	:	704-358-0876

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

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	01/28/2010

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