Provider Demographics
NPI:1952419780
Name:MANNAS-STEVENS, GLADYS J (LCSW)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:J
Last Name:MANNAS-STEVENS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5817 COOPERS RIDGE LN
Mailing Address - Street 2:PH
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1032
Mailing Address - Country:US
Mailing Address - Phone:704-562-7657
Mailing Address - Fax:704-947-2278
Practice Address - Street 1:4822 ALBEMARLE RD
Practice Address - Street 2:SUITE 112
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6668
Practice Address - Country:US
Practice Address - Phone:704-562-7657
Practice Address - Fax:704-947-2278
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0047101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003723Medicaid
NC6003723Medicaid