Provider Demographics
NPI:1790532042
Name:ANIBALDI, ATHENA ALVARADO (LCMHCA)
Entity type:Individual
Prefix:
First Name:ATHENA
Middle Name:ALVARADO
Last Name:ANIBALDI
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:ATHENA
Other - Middle Name:VENICE
Other - Last Name:ALVARADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8605 DIGITAL DR APT 204
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1318
Mailing Address - Country:US
Mailing Address - Phone:704-232-1018
Mailing Address - Fax:
Practice Address - Street 1:6813 FAIRVIEW RD STE C
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3364
Practice Address - Country:US
Practice Address - Phone:704-909-6085
Practice Address - Fax:704-220-2366
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19784101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health