Provider Demographics
NPI:1356188668
Name:HERNANDEZ, YULISSA MORAN (MSW, LCSWA)
Entity type:Individual
Prefix:MS
First Name:YULISSA
Middle Name:MORAN
Last Name:HERNANDEZ
Suffix:
Gender:
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 UNION ST S STE 200
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-5098
Mailing Address - Country:US
Mailing Address - Phone:704-918-9741
Mailing Address - Fax:704-270-6213
Practice Address - Street 1:11 UNION ST S STE 200
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-5098
Practice Address - Country:US
Practice Address - Phone:704-918-9741
Practice Address - Fax:704-270-6213
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP020862104100000X, 1041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker