Healthcare Provider Details

I. General information

NPI: 1154036804
Provider Name (Legal Business Name): MARGARET'S HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2113 SPEEDWELL CT
CHARLOTTE NC
28213-4228
US

IV. Provider business mailing address

2113 SPEEDWELL CT
CHARLOTTE NC
28213-4228
US

V. Phone/Fax

Practice location:
  • Phone: 917-319-5063
  • Fax:
Mailing address:
  • Phone: 917-319-5063
  • Fax:

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: MS. DELIA ALIENE SUMTER
Title or Position: SOCIAL WORKER
Credential: MSW
Phone: 917-319-5063