Healthcare Provider Details

I. General information

NPI: 1053053611
Provider Name (Legal Business Name): NOVA LUX COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N TRYON ST STE 112
CHARLOTTE NC
28246-0104
US

IV. Provider business mailing address

101 N TRYON ST STE 112
CHARLOTTE NC
28246-0104
US

V. Phone/Fax

Practice location:
  • Phone: 475-237-4575
  • Fax: 866-213-3606
Mailing address:
  • Phone: 475-237-4575
  • Fax: 866-213-3606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. BOBBY KATO
Title or Position: OWNER
Credential: MD, PHD, MS, LPC
Phone: 475-289-0884