Healthcare Provider Details

I. General information

NPI: 1235662230
Provider Name (Legal Business Name): PRIORITY SUCCESS ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 MINERAL SPRINGS RD
CHARLOTTE NC
28262-4920
US

IV. Provider business mailing address

1518 MINERAL SPRINGS RD
CHARLOTTE NC
28262
US

V. Phone/Fax

Practice location:
  • Phone: 704-332-1178
  • Fax:
Mailing address:
  • Phone: 704-332-1178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: BALRIE PARKS
Title or Position: PRESIDENT
Credential: M.ED
Phone: 704-332-1178