Individual
DENESE ETHERIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4615 POTTERS GLEN RD, CHARLOTTE, NC 28269-7351
(252) 339-5655
Mailing address
4615 POTTERS GLEN RD, CHARLOTTE, NC 28269-7351
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
P007541
—
Other
Enumeration date
06/17/2013
Last updated
06/17/2013
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