Provider Demographics
NPI:1194153122
Name:TRUESDALE, THANDIWE IRVIN (LCSW)
Entity type:Individual
Prefix:
First Name:THANDIWE
Middle Name:IRVIN
Last Name:TRUESDALE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4919 ALBEMARLE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-6683
Mailing Address - Country:US
Mailing Address - Phone:980-495-6305
Mailing Address - Fax:980-495-6535
Practice Address - Street 1:4919 ALBEMARLE RD STE 203
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6683
Practice Address - Country:US
Practice Address - Phone:980-495-6305
Practice Address - Fax:980-495-6535
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500793561041C0700X
NCC0106631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical