Provider Demographics
NPI:1407296510
Name:ANTRANIQUE NEBLETT, LCSW
Entity Type:Organization
Organization Name:ANTRANIQUE NEBLETT, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANTRANIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEBLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-251-5146
Mailing Address - Street 1:4651 CHARLOTTE PARK DR
Mailing Address - Street 2:SUITE 101-E
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-1956
Mailing Address - Country:US
Mailing Address - Phone:704-251-5146
Mailing Address - Fax:
Practice Address - Street 1:4651 CHARLOTTE PARK DR
Practice Address - Street 2:SUITE 101-E
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-1956
Practice Address - Country:US
Practice Address - Phone:704-251-5146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0081831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty