MEDICARE: MIKKI WARSZAWSKI LCMHCA

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	101YM0800X	Mental Health Counselor	A15991	NC

General Provider Information

NPI Number	:	1720691371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKKI WARSZAWSKI LCMHCA

Provider Business Mailing Address
First Line	:	156 RAIL CROSSING LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-1156
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6813 FAIRVIEW RD STE C
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3364
Country	:	US
Telephone Number	:	919-998-8473
Fax Number	:

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

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	08/24/2020

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