MEDICARE: MALIA SUHREN MSW, 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	1041C0700X	Clinical Social Worker	P018107	NC

General Provider Information

NPI Number	:	1972280964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALIA SUHREN MSW, LCSW

Provider Business Mailing Address
First Line	:	8508 PARK RD # 384
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-5803
Country	:	US
Telephone Number	:	704-981-2676
Fax Number	:	704-228-0005

Provider Business Practice Location Address
First Line	:	360 NORTH CASWELL ROAD.
Second Line	:	SUITE. 303
City	:	CHARLOTTE
State	:	NC
Zip	:	28204
Country	:	US
Telephone Number	:	704-981-2676
Fax Number	:	704-228-0005

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

Provider Enumeration Date	:	06/30/2023
Last Update Date	:	03/25/2026

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