Individual
CHARMAINE SOPHIA-SAMARA FORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAS-A
Contact information
Practice address
2106 AYRSLEY TOWN BLVD UNIT B, CHARLOTTE, NC 28273-4217
(252) 258-7627
Mailing address
2106 AYRSLEY TOWN BLVD UNIT B, CHARLOTTE, NC 28273-4217
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
3164-A
NC
104100000X
Social Worker
—
—
Other
Enumeration date
03/22/2013
Last updated
03/22/2013
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