Provider Demographics
NPI:1033599436
Name:ESPAILLAT, MIRIAM GRISELDA
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:GRISELDA
Last Name:ESPAILLAT
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 1:300 N COLLEGE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2198
Mailing Address - Country:US
Mailing Address - Phone:704-299-6988
Mailing Address - Fax:
Practice Address - Street 1:300 N COLLEGE ST STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2198
Practice Address - Country:US
Practice Address - Phone:042-996-9887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0123451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP008567OtherNC LCSWA