Provider Demographics
NPI:1023386067
Name:NEBLETT, ANTRANIQUE (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:ANTRANIQUE
Middle Name:
Last Name:NEBLETT
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4651 CHARLOTTE PARK DR STE 101C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-1916
Mailing Address - Country:US
Mailing Address - Phone:704-251-5146
Mailing Address - Fax:844-331-1422
Practice Address - Street 1:4651 CHARLOTTE PARK DR
Practice Address - Street 2:101C
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-1916
Practice Address - Country:US
Practice Address - Phone:704-251-5146
Practice Address - Fax:844-331-1422
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1023386067Medicaid
NCQ43208AMedicare PIN