Healthcare Provider Details

I. General information

NPI: 1124310396
Provider Name (Legal Business Name): OPEN HEARTS OPEN MINDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7609 DELUCA DR
CHARLOTTE NC
28215-5313
US

IV. Provider business mailing address

7609 DELUCA DR
CHARLOTTE NC
28215-5313
US

V. Phone/Fax

Practice location:
  • Phone: 704-536-0737
  • Fax:
Mailing address:
  • Phone: 704-536-0737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number5488
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5488
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5488
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateNC

VIII. Authorized Official

Name: MRS. LASHICA HEMINGWAY
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC, NBC
Phone: 704-536-0737