Individual
MIRANDA GAIL FETHERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
514 FRANK DR, CHARLOTTE, NC 28215-2113
(704) 453-5011
Mailing address
514 FRANK DR, CHARLOTTE, NC 28215-2113
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
02/27/2019
Last updated
02/27/2019
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