Healthcare Provider Details

I. General information

NPI: 1598514770
Provider Name (Legal Business Name): MOSAIC INTEGRATIVE COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2024
Last Update Date: 05/18/2024
Certification Date: 05/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 JOHNSTON RD STE 210
CHARLOTTE NC
28226-0920
US

IV. Provider business mailing address

10801 JOHNSTON RD STE 210
CHARLOTTE NC
28226-0920
US

V. Phone/Fax

Practice location:
  • Phone: 704-830-5000
  • Fax:
Mailing address:
  • Phone: 704-830-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHELLE MARTIN HURLBERT
Title or Position: OWNER
Credential: LCMHCS
Phone: 704-830-5000