Healthcare Provider Details

I. General information

NPI: 1376054064
Provider Name (Legal Business Name): PEACE POWER & PURPOSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 02/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10709 GLENLUCE AVE
CHARLOTTE NC
28213-4239
US

IV. Provider business mailing address

10709 GLENLUCE AVE
CHARLOTTE NC
28213-4239
US

V. Phone/Fax

Practice location:
  • Phone: 704-264-7769
  • Fax:
Mailing address:
  • Phone: 704-264-7769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: KEONNA SYMONE TEASLEY
Title or Position: CO-FOUNDER
Credential:
Phone: 704-264-7769