MEDICARE: ALYSSA MARIE BEHNKE 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	104100000X	Social Worker	C011396	NC
2	1041C0700X	Clinical Social Worker	C011396	NC

General Provider Information

NPI Number	:	1629453162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA MARIE BEHNKE LCSW

Provider Business Mailing Address
First Line	:	PO BOX 19305
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28219-9305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1237 HARDING PL
Second Line	:	STE 3300
City	:	CHARLOTTE
State	:	NC
Zip	:	28204
Country	:	US
Telephone Number	:	704-446-5860
Fax Number	:

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

Provider Enumeration Date	:	07/27/2015
Last Update Date	:	05/28/2026

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