1316129984 NPI number — POSITIVE REFLECTION COUNSELING

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316129984 NPI number — POSITIVE REFLECTION COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POSITIVE REFLECTION COUNSELING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316129984
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 681749
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28216-0033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-405-4901
Provider Business Mailing Address Fax Number:
704-405-4902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 N TRYON ST
Provider Second Line Business Practice Location Address:
STE. 107
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28206-2704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-405-4901
Provider Business Practice Location Address Fax Number:
704-405-4902
Provider Enumeration Date:
12/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE-QUARLES
Authorized Official First Name:
CHELANDRA
Authorized Official Middle Name:
SHAWNTE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
704-405-4901

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  5529 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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