Provider Demographics
NPI:1417828294
Name:SIMIEN, CHARQUELE
Entity type:Individual
Prefix:
First Name:CHARQUELE
Middle Name:
Last Name:SIMIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHARLY
Other - Middle Name:
Other - Last Name:SIMIEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMBT
Mailing Address - Street 1:10856 OVERLOOK MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-7814
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10856 OVERLOOK MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-7814
Practice Address - Country:US
Practice Address - Phone:910-920-8252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22217225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty