MEDICARE: KIAM MALIJA SEYMOUR 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	P021748	NC

General Provider Information

NPI Number	:	1699258996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIAM MALIJA SEYMOUR LCSWA

Provider Business Mailing Address
First Line	:	200 QUEENS RD STE 300
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-3257
Country	:	US
Telephone Number	:	704-980-3082
Fax Number	:	704-980-3082

Provider Business Practice Location Address
First Line	:	200 QUEENS RD STE 300
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-3257
Country	:	US
Telephone Number	:	704-980-3082
Fax Number	:	704-980-3082

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

Provider Enumeration Date	:	09/12/2018
Last Update Date	:	02/27/2025

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