Provider Demographics
NPI:1922493444
Name:POLK, INOBEME (LCSW-A)
Entity Type:Individual
Prefix:MR
First Name:INOBEME
Middle Name:
Last Name:POLK
Suffix:
Gender:M
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 MEDICAL PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-8797
Mailing Address - Country:US
Mailing Address - Phone:704-208-4458
Mailing Address - Fax:866-309-6385
Practice Address - Street 1:8401 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262
Practice Address - Country:US
Practice Address - Phone:704-208-4458
Practice Address - Fax:866-309-6385
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP009356101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health