Healthcare Provider Details

I. General information

NPI: 1407109820
Provider Name (Legal Business Name): NULIFE CONSULTING & THERAPEUTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5513 MONROE RD SUITE 204
CHARLOTTE NC
28212-5503
US

IV. Provider business mailing address

5513 MONROE RD SUITE 204
CHARLOTTE NC
28212-5503
US

V. Phone/Fax

Practice location:
  • Phone: 980-239-4383
  • Fax:
Mailing address:
  • Phone: 980-239-4383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KASAUNDRA DENISE MOODY
Title or Position: CEO
Credential:
Phone: 980-239-4383