Provider Demographics
NPI:1972280964
Name:SUHREN, MALIA (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:MALIA
Middle Name:
Last Name:SUHREN
Suffix:
Gender:F
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 1:8508 PARK RD # 384
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-5803
Mailing Address - Country:US
Mailing Address - Phone:704-981-2676
Mailing Address - Fax:704-228-0005
Practice Address - Street 1:360 NORTH CASWELL ROAD.
Practice Address - Street 2:SUITE. 303
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204
Practice Address - Country:US
Practice Address - Phone:704-981-2676
Practice Address - Fax:704-228-0005
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0181071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical