Provider Demographics
NPI:1649849654
Name:FISCHETTI, MEGAN GRUBBS (LCSWA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:GRUBBS
Last Name:FISCHETTI
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 PECAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-3452
Mailing Address - Country:US
Mailing Address - Phone:804-517-0795
Mailing Address - Fax:
Practice Address - Street 1:447 S SHARON AMITY RD STE 105
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2836
Practice Address - Country:US
Practice Address - Phone:980-299-7436
Practice Address - Fax:980-226-5507
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical