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Individual

MRS. OMEGA RUSHING AUTRY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CDMS

Contact information

Practice address
416 FARMHURST DR, CHARLOTTE, NC 28217-4923
(704) 523-0021
(704) 523-0809
Mailing address
416 FARMHURST DR, CHARLOTTE, NC 28217-4923
(704) 523-0021
(704) 523-0809

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
00046115
IL

Other

Enumeration date
05/06/2015
Last updated
05/06/2015
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