Provider Demographics
NPI:1649886714
Name:SUROS, CIARA MONIQUE (MSW, LCSW-A, LCAS)
Entity type:Individual
Prefix:
First Name:CIARA
Middle Name:MONIQUE
Last Name:SUROS
Suffix:
Gender:
Credentials:MSW, LCSW-A, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 CARBONTON RD STE 118
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4000
Mailing Address - Country:US
Mailing Address - Phone:803-306-2458
Mailing Address - Fax:
Practice Address - Street 1:715 N HORNER BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-3517
Practice Address - Country:US
Practice Address - Phone:803-306-2458
Practice Address - Fax:472-202-4636
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0153091041C0700X
NC26738101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)