MEDICARE: MICHELLE N ANTHONY

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	P017105	NC

General Provider Information

NPI Number	:	1790427755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE N ANTHONY

Provider Business Mailing Address
First Line	:	1921 WATERS TRAIL DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-8834
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4822 ALBEMARLE RD STE 103
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6612
Country	:	US
Telephone Number	:	980-207-0072
Fax Number	:

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

Provider Enumeration Date	:	04/11/2022
Last Update Date	:	04/11/2022

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Directions to “ MICHELLE N ANTHONY ” Practice Location

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