Provider Demographics
NPI:1447786918
Name:BYRON, CHARISSE SLOANE-SEALE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHARISSE
Middle Name:SLOANE-SEALE
Last Name:BYRON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHARISSE
Other - Middle Name:
Other - Last Name:SLOANE-SEALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9900 POPLAR TENT RD STE 115
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-9505
Mailing Address - Country:US
Mailing Address - Phone:704-284-9314
Mailing Address - Fax:
Practice Address - Street 1:2301 ROBESON STREET
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305
Practice Address - Country:US
Practice Address - Phone:347-534-6126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0104671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical