Provider Demographics
NPI:1740808104
Name:TORRES, INDIANA I (LCSWA)
Entity type:Individual
Prefix:
First Name:INDIANA
Middle Name:I
Last Name:TORRES
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:INDIANA
Other - Middle Name:I
Other - Last Name:REYNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3439 VICTORIA BROOK LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-4257
Mailing Address - Country:US
Mailing Address - Phone:980-333-7422
Mailing Address - Fax:
Practice Address - Street 1:1909 J N PEASE PL STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4509
Practice Address - Country:US
Practice Address - Phone:980-313-3020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0147701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical