Provider Demographics
NPI:1447361134
Name:RIEDL, KARA BROOKE (LCSWA)
Entity type:Individual
Prefix:MRS
First Name:KARA
Middle Name:BROOKE
Last Name:RIEDL
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4507 CREWE HALL LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7084
Mailing Address - Country:US
Mailing Address - Phone:315-877-3523
Mailing Address - Fax:
Practice Address - Street 1:10420 PARK RD STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8502
Practice Address - Country:US
Practice Address - Phone:980-237-4766
Practice Address - Fax:980-404-2274
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068478104100000X
NCP018128104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker