Healthcare Provider Details

I. General information

NPI: 1922657873
Provider Name (Legal Business Name): CALADRIUS THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 QUEENS RD STE 300
CHARLOTTE NC
28204-3257
US

IV. Provider business mailing address

200 QUEENS RD STE 300
CHARLOTTE NC
28204-3257
US

V. Phone/Fax

Practice location:
  • Phone: 704-980-3082
  • Fax: 704-709-1344
Mailing address:
  • Phone: 704-980-3082
  • Fax: 704-709-1344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
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 Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JESSIE LEE OGIENKO
Title or Position: OWNER
Credential:
Phone: 704-980-3082