1669749644 NPI number — CHARLOTTE FAMILY COUNSELING CENTER, PLLC

Table of content: (NPI 1669749644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669749644 NPI number — CHARLOTTE FAMILY COUNSELING CENTER, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLOTTE FAMILY COUNSELING CENTER, PLLC
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:
6
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:
1669749644
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1362 SECRET PATH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MILL
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29708-6545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-236-9390
Provider Business Mailing Address Fax Number:
803-693-0701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 TYVOLA RD
Provider Second Line Business Practice Location Address:
STE 304
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28217-3515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-236-9390
Provider Business Practice Location Address Fax Number:
803-693-0701
Provider Enumeration Date:
11/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ROAN
Authorized Official First Name:
SYLVIA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
704-236-9390

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  C006890 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X , with the licence number: 9585 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com