Healthcare Provider Details

I. General information

NPI: 1235436585
Provider Name (Legal Business Name): INDEPENDENCE THROUGH EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2011
Last Update Date: 07/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 DARBY AVE
CHARLOTTE NC
28216-4009
US

IV. Provider business mailing address

PO BOX 1486
DAVIDSON NC
28036-1486
US

V. Phone/Fax

Practice location:
  • Phone: 704-765-4880
  • Fax: 206-337-9861
Mailing address:
  • Phone: 704-765-4880
  • Fax: 678-696-6411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN HICKS
Title or Position: CEO - THE NAMASTE NETWORK
Credential:
Phone: 704-765-4880