Provider Demographics
NPI:1902602238
Name:GUTIERREZ, IRMA CITLALLI (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:IRMA
Middle Name:CITLALLI
Last Name:GUTIERREZ
Suffix:
Gender:
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8416 AMELIA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-9005
Mailing Address - Country:US
Mailing Address - Phone:980-939-4230
Mailing Address - Fax:
Practice Address - Street 1:110 UNIONVILLE INDIAN TRAIL RD
Practice Address - Street 2:STE.-C100
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079
Practice Address - Country:US
Practice Address - Phone:704-438-9901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0192311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical