Provider Demographics
NPI:1609474915
Name:MYERS, KAREN DORIS (LCSW, ACHP-SW)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:DORIS
Last Name:MYERS
Suffix:
Gender:F
Credentials:LCSW, ACHP-SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 ROSWELL AVE UNIT 301
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-1683
Mailing Address - Country:US
Mailing Address - Phone:704-942-5999
Mailing Address - Fax:
Practice Address - Street 1:2503 ROSWELL AVE UNIT 301
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-1683
Practice Address - Country:US
Practice Address - Phone:704-942-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOO62861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical