Healthcare Provider Details

I. General information

NPI: 1881011666
Provider Name (Legal Business Name): THE ESSENCE OF ME CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6705 MALLARD CREEK RD
CHARLOTTE NC
28262-2212
US

IV. Provider business mailing address

6705 MALLARD CREEK RD
CHARLOTTE NC
28262-2212
US

V. Phone/Fax

Practice location:
  • Phone: 919-333-7657
  • Fax:
Mailing address:
  • Phone:
  • 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 Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGELA THORPE-MOSS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MSP
Phone: 919-333-7657