Healthcare Provider Details

I. General information

NPI: 1154464089
Provider Name (Legal Business Name): COUNSELING CENTER AT CHARLOTTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 W CARSON BLVD
CHARLOTTE NC
28203
US

IV. Provider business mailing address

328 W CARSON BLVD
CHARLOTTE NC
28203
US

V. Phone/Fax

Practice location:
  • Phone: 704-375-9025
  • Fax: 704-375-0054
Mailing address:
  • Phone: 704-375-9025
  • Fax: 704-375-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNC

VIII. Authorized Official

Name: MR. THOMAS HOLLAND ONEAL
Title or Position: DIRECTOR
Credential: LPC
Phone: 704-375-9025