Provider Demographics
NPI:1275303240
Name:DRAGE, ANNA GRACE
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:GRACE
Last Name:DRAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 GREEN OAKS LN APT J
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-8323
Mailing Address - Country:US
Mailing Address - Phone:252-558-5249
Mailing Address - Fax:
Practice Address - Street 1:811 CENTRAL AVE STE 8
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2015
Practice Address - Country:US
Practice Address - Phone:252-558-5249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0176901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical