Provider Demographics
NPI:1184224727
Name:WINN, KWANZA SUZANNE (LMSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:KWANZA
Middle Name:SUZANNE
Last Name:WINN
Suffix:
Gender:F
Credentials:LMSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9805 STATESVILLE RD STE 6486
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-7647
Mailing Address - Country:US
Mailing Address - Phone:704-710-6495
Mailing Address - Fax:
Practice Address - Street 1:2510 HOPE WAY LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-6954
Practice Address - Country:US
Practice Address - Phone:704-710-6495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0155391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical