Healthcare Provider Details

I. General information

NPI: 1356260079
Provider Name (Legal Business Name): JOY SELF LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 CARMEL EXECUTIVE PARK DR STE 200
CHARLOTTE NC
28226-4207
US

IV. Provider business mailing address

205 S KINGS DR APT 241
CHARLOTTE NC
28204-2670
US

V. Phone/Fax

Practice location:
  • Phone: 980-800-4323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23070
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: